The Systematic Evaluation of Identifying the Infarct Related Artery Utilizing Cardiac Magnetic Resonance in Patients Presenting with ST-Elevation Myocardial Infarction.
Citation: PLoS ONE [Electronic Resource]. 12(1):e0169108, 2017PMID: 28060863Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Electrocardiography | *Magnetic Resonance Imaging | *Myocardial Infarction/di [Diagnosis] | *Myocardial Infarction/pp [Physiopathology] | Aged | Coronary Angiography | Humans | Image Processing, Computer-Assisted | Magnetic Resonance Imaging/mt [Methods] | Middle Aged | Multicenter Studies as Topic | Myocardial Infarction/co [Complications] | Myocardial Infarction/th [Therapy] | Percutaneous Coronary Intervention | Randomized Controlled Trials as TopicYear: 2017Local holdings: Available online through MWHC library: 2006 - presentISSN:- 1932-6203
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 28060863 | Available | 28060863 |
Available online through MWHC library: 2006 - present
BACKGROUND: Identification of the infarct-related artery (IRA) in patients with STEMI using coronary angiography (CA) is often based on the ECG and can be challenging in patients with severe multi-vessel disease. The current study aimed to determine how often percutaneous intervention (PCI) is performed in a coronary artery different from the artery supplying the territory of acute infarction on cardiac magnetic resonance imaging (CMR).
CONCLUSIONS: In this select population of patients, the identification of the IRA by CA was incorrect in 4% of patients presenting with STEMI. Four patients with a mismatch had an acute infarction in more than one coronary artery territory on CMR. The role of CMR in patients presenting with STEMI with multi-vessel disease on CA deserves further investigation.
METHODS: We evaluated 113 patients from the Reduction of infarct Expansion and Ventricular remodeling with Erythropoetin After Large myocardial infarction (REVEAL) trial, who underwent CMR within 4+/-2 days of revascularization. Blinded reviewers interpreted CA to determine the IRA and CMR to determine the location of infarction on a 17-segment model. In patients with multiple infarcts on CMR, acuity was determined with T2-weighted imaging and/or evidence of microvascular obstruction.
RESULTS: A total of 5 (4%) patients were found to have a mismatch between the IRA identified on CMR and CA. In 4/5 cases, there were multiple infarcts noted on CMR. Thirteen patients (11.5%) had multiple infarcts in separate territories on CMR with 4 patients (3.5%) having multiple acute infarcts and 9 patients (8%) having both acute and chronic infarcts.
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