ArticleLa Radiologia medica2026
The FIBR-CMR score: a novel risk model integrating fibrinogen and cardiac magnetic resonance for major adverse events after STEMI.
Article in La Radiologia medica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03768453 (EARLY-MYO-CMR), which is not on this map. Not yet cited in PubMed.
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The trial behind it
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EARLY-MYO-CMR (EARLY Assessment of MYOcardial Tissue Characteristics by CMR in STEMI) Registry
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9 authors.
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Abstract
backgroundSurvivors of ST-segment elevation myocardial infarction (STEMI) face a substantial residual risk of major adverse cardiovascular and cerebrovascular events (MACCEs). Cardiac magnetic resonance (CMR) excellently delineates structural injury but does not assess the concomitant systemic prothrombotic state. We investigated whether fibrinogen, a key mediator of thrombosis, provides incremental prognostic value beyond CMR for risk stratification.
methodsIn a prospective multicenter cohort of 532 STEMI patients undergoing primary percutaneous coronary intervention (PCI), plasma fibrinogen was measured post-procedure. CMR was performed within 7 days to assess left ventricular thrombus (LVT) and aneurysm (LVA). The primary endpoint was MACCEs over a median follow-up of 55.5 months. A novel risk score (the Fibrinogen and Cardiac Magnetic Resonance Score, or FIBR-CMR score) was derived from a multivariable Cox model, and its performance was assessed through internal validation using bootstrap resampling (optimism-corrected C-index = 0.73).
resultsElevated fibrinogen independently predicted LVT (adjusted OR 1.46, 95% CI 1.09-1.96) and LVA (adjusted OR 1.47, 95% CI 1.20-1.79) after adjusting for clinical and CMR confounders. Fibrinogen (≥ 3.36 g/L) independently predicted MACCEs (HR 1.30, 95% CI 1.10-1.53), an effect partially mediated by LVT (48.5%) and LVA (38.0%). The FIBR-CMR score (1 point for elevated fibrinogen, 2 for LVT, 2 for LVA) stratified patients into low (0 points), intermediate (1-2 points), and high (≥ 3 points) risk groups. The high-risk group had a strikingly elevated 5-year MACCE incidence of 48.3%, compared to 15.2% and 6.0% in the intermediate- and low-risk groups, respectively (optimism-corrected C-index = 0.73).
conclusionThe integration of fibrinogen with CMR-defined structural injury provides powerful synergism for risk assessment. The FIBR-CMR score, derived from a prospective multicenter cohort, effectively identifies a high-risk phenotype of STEMI patients. This score now requires external validation but represents a promising step toward personalized risk assessment. CLINICAL
trial registrationClinicaltrials.gov; NCT03768453.
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