BACKGROUND: The incremental prognostic value of integrating myocardial cine radiomics into predictive models for major adverse cardiovascular events (MACE) risk in patients with ST-elevation myocardial infarction (STEMI) is unclear. PURPOSE: To determine if myocardial cine radiomics can improve risk assessment for MACE when combined with clinical information and cardiac MRI parameters in STEMI patients. STUDY TYPE: Retrospective. SUBJECTS: One thousand twenty-four STEMI patients (83% male
mean age 59 ± 11 years) from two centers, divided into training (819 patients) and external testing (205 patients) cohorts. FIELD STRENGTH/SEQUENCE: 3.0 T/balanced steady-state free precession cine, and phase-sensitive inversion recovery sequences. ASSESSMENT: The Rad_score was calculated as a weighted sum of independent radiomic variables derived from the logistic regression model, providing a concise representation of their combined prognostic impact. Six risk models were developed, incorporating varying combinations of MRI parameters, clinical variables, and Rad_score to comprehensively evaluate their prognostic performance. A final risk stratification, integrating left ventricular ejection fraction (LVEF), the extent of late gadolinium enhancement (LGE), and Rad_score, was established and compared with one based on LVEF alone. STATISTICAL TESTS: The prognostic implications of the Rad_score were evaluated using univariable and multivariable Cox proportional hazards models. A P value <
0.05 was considered significant. RESULTS: During a median follow-up of 3.1 years, 139 patients (17%) in the training set and 30 patients (15%) in the testing set experienced MACE. Rad_score was identified as a significant risk factor for MACE, with a hazard ratio of 1.46 (1.38-1.55) (P <
0.01) in univariate Cox analysis. The risk stratification reclassified the risk for 33% of the study population in the training set and 34% in the testing set. DATA CONCLUSION: Myocardial cine radiomics are associated with MACE risk in STEMI patients and provide incremental improvement in risk stratification when combined with traditional parameters. PLAIN LANGUAGE SUMMARY: The development of radiomics has introduced new perspectives in both the diagnosis and prognosis of cardiovascular diseases. However, the incremental prognostic value of incorporating myocardial cine radiomics into predictive models for major adverse cardiovascular events (MACE) risk in patients with ST-elevation myocardial infarction (STEMI) remains unclear. This study integrates radiomics with traditional clinical parameters and cardiac magnetic resonance imaging (MRI) to evaluate its added value in assessing MACE risk in STEMI patients. The results demonstrate that radiomics is significantly associated with MACE and provides incremental value in risk stratification. These findings offer a novel approach to improve personalized risk assessment, making it a valuable addition to the cardiovascular field. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 5.