Assistant Professor of Medicine Indiana University School of Medicine RAJKOT, Gujarat, India
Need statement: Adults with reperfused STEMI need a very-early, scalable triage layer that identifies patients at high risk of intramyocardial hemorrhage (IMH; CCS-AMI Stage IV) and targets precision CMR where it changes care. Universal CMR for all AMI patients is impractical (timing, access, contraindications, cost). Programs require early guidance on who should undergo CMR and when, so that CMR can quantify final infarct size after expansion, microvascular obstruction (MVO), and IMH volume—metrics that stratify risk and inform precision therapies and monitoring. Target population: adults with AMI treated by PCI or thrombolysis across ED–cath–ICU settings, including resource-limited centers.
Measurable Goal: By ≤3 h post-reperfusion, discriminate Stage IV vs. Stages I–III against a blinded in-hospital CMR reference with AUROC ≥0.85, sensitivity ≥85%, specificity ≥85%, and macro-F1 ≥0.80 at adjacent boundaries. Operational goals: time-to-decision ≤60 min; indeterminate rate ≤5% with reflex-imaging rules; ≥30% reallocation of CMR capacity toward high-yield patients and ≥25% reduction in low-yield scans. CMR yield goals among scanned patients: ≥95% standardized reports containing final infarct size (post-expansion), MVO extent, and IMH volume; ≥80% linkage of these metrics to documented care-plan actions (therapy intensity, monitoring, or follow-up timing) via pre-specified thresholds.
Current vs. Goal Capabilities: Current: Early AMI pathways rely on ECG/angiography/hemodynamics and nonspecific labs; CMR—the reference for IMH, MVO, and infarct characterization—is often delayed (24–72 h), variably available, and inconsistently used to steer therapy. No standardized early triage layer prioritizes who receives CMR and when, and quantitative CMR outputs are not consistently mapped to care pathways. Goal: A solution-agnostic, interpretable early triage that directs who/when to scan, paired with standardized CMR reporting of final infarct size (after expansion), MVO, and IMH volume that reliably guides precision-therapy decisions and follow-up across centers.
Must-Have Features:
Early-window applicability: pre-PCI to ≤3 h post-reperfusion (≤12 h acceptable).
External, multi-center validation vs blinded CMR reference.
Clear outputs: stage probabilities, CMR priority & optimal timing, indeterminate flag with reflex rules.
Rapid turnaround (≤60 min); low operational burden; robust to confounders and sampling time.
Consistency across culprit territories; auditable QC; registry-ready fields.
Workflow fit: ED–cath–ICU integration with seamless scheduling/hand-offs.
Nice-to-Have Features:
Serial trajectory over the first 24–48 h to refine CMR timing and risk.
EHR integration for alerts, order sets, and CMR slot management; vendor-neutral interoperability.
Trial-readiness: harmonized data elements for SCMR registries and multi-site studies; clinician-friendly visuals to support shared decisions.
