Abstract 166: Short-Term Total Myocardial Ischemia Solely Does Not Cause Significant Myocardial Injury
Introduction; In out-of-hospital cardiac arrest patients, there is no data about myocardial injury of total myocardial ischemia due to cardiac arrest. Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) is useful tool to detect major myocardial ischemic injury and LGE was founded especially in subendocardial layer.
Hypothesis; There are no significant myocardial injuries especially in normal coronary artery patients.
Methods; We performed LGE-MRI for total fifty-one consecutive out-of-hospital cardiac arrest patients between January 2008 and March 2011. We exclude patients who need percutaneous cardio-pulmonary system to survive, whose coronary perfusion was not guaranteed. Emergent coronary angiography was performed on admission to check coronary artery patency and angioplasty was performed when there was significant stenosis. We compared the normal coronary anatomy group (NA group, n=27) and coronary artery disease group (CAD group, n=24).
Results; There were no significant ischemic time differences between these two groups; time to cardio-pulmonary resuscitation was 4.8min vs 3.6min, p=0.36, time to return of spontaneous circulation was and 17.1min vs 22.0min, p=0.2, respectively. Peak creatinine kinase was not significant different between two groups (1875 IU/L vs 2468 IU/L, p=0.44), but peak myocardial isoenzyme, CK-MB was significantly lower in normal coronary groups (34IU/L vs 162IU/L, p=0.01). LGE was founded in all CAD patients (100%) and the LGE lesion was compatible with coronary artery anatomy. On the other hand, LGE was founded in six patients of NA group (6/24; 25%) and LGE in subendocardial layer was founded in only two patients (2/24; 8.3%). These two patients was diagnosed as vasospastic angina which was confirmed by provocation test. In the other four patients, the central wall of the intraventricular septum was affected. Therefore, no patients with true normal coronary artery had subendocardial myocardial infarction due to total coronary ischemia.
Conclusion: Immediate cardio-pulmonary resuscitation and about 20 minutes total myocardial ischemia due to cardiac arrest did not induce major myocardial injury, which was detected by LGE-MRI, especially to normal coronary artery patients.
- Cardiac arrest
- Magnetic resonance imaging
- Myocardial perfusion
- Cardiopulmonary resuscitation
- © 2011 by American Heart Association, Inc.