Abstract 17448: Myocardial Late Enhancement on 320 Detector-row CT in Patients Immediately after Primary Percutaneous Coronary Intervention is Strongly Associated with Microvascular Obstruction on CMR
Introduction: Late enhancement on computed tomography (CT-LE) early after successful primary percutaneous coronary intervention (PCI) of acute myocardial infarction (AMI) may provide prediction of functional recovery without additional iodine injection.
Hypothesis: We hypothesized that CT-LE is associated with microvascular obstruction (MO) on cardiac magnetic resonance (CMR) that has been shown to be a predictor of poor functional recovery and risk of adverse event.
Methods: Seventeen consecutive patients (mean age 63±13 years, 15 men) underwent 320 slice CT and CMR after successful PCI for AMI (peak creatine kinase(CK) 2167±1159 mg/dl). Thrombolysis in myocardial infarction (TIMI) flow grade 3 was achieved in all patients. Additional radiation dose by CT-LE study using 320 slice CT was < 2mSV. Rest perfusion MRI and late gadolinium enhanced (LGE) MRI were acquired with a 1.5T MR imager with 32-ch coils.
Result: Mean total contrast volume used during PCI was 168±32ml. CT and CMR were performed 21.7±6.5min and 6.0±4days after PCI. Myocardial infarction was detected in all patients by both CT and CMR. MO was found in 12 patients by CMR (71%). Mean CT-LE volume was 17.1±12.5ml, which was smaller than LGE volume (32.0±17.6ml, p<0.001) but larger than MO volume (3.04±4.64ml, p<0.001). CT-LE showed significant correlation with MO volume (r=0.75, p<0.01), LGE volume (r=0.76, p<0.001), and peak CK (r=0.60, p<0.001). In multiple regression analysis, CT-LE (β=0.75, p<0.01) showed the strongest correlation with MO among other predictive factors such as peak CK, time from onset, blush score, contrast volume, time between PCI and MDCT.
Conclusion: CT-LE observed in AMI patients after successful PCI has a strong relation with MO. CT-LE imaging immediately after primary PCI may provide useful information regarding myocardial viability and prognosis without additional contrast injection.
- © 2010 by American Heart Association, Inc.