Abstract 16470: The Accuracy of Detection of Microvascular Obstruction by Multidetector Computed Tomography Immediately After Coronary Angiography in Acute Myocardial Infarction
Objectives: This study evaluated the clinical value of myocardial contrast delayed enhancement (DE) with multidetector computed tomography (MDCT) for predicting microvascular obstruction (MVO) by delayed enhancement magnetic resonance imaging (DE-MRI) after acute myocardial infarction (AMI).
Methods: In 54 patients with first AMI, MDCT without iodine reinjection was performed immediately following successful percutaneous coronary intervention (PCI). DE-MRI performed within 7days after onset was used to detect MVO. We divided into three groups according to the myocardial DE patterns; transmural, subendocardial and no contrast-delayed enhancement. The CT density of contrast enhanced myocardium and non-enhanced myocardium were analyzed on MDCT. The relative CT density was calculated as the value of the density of contrast enhanced myocardium / non-enhanced myocardium for each patient. Patients were divided into 2 groups according to the presence (Group I, n=25) or absence (Group II, n=29) of MVO.
Results: The rate of transmural pattern and the relative CT density was significantly higher in Group I than in Group II (84% vs 3%, P<0.001, 2.83±0.53 vs 1.89±0.49, P<0.001 ). The receiver-operating characteristic analysis showed the best cut off point of the relative CT density was 2.31 for prediction of MVO. In the multivariate analysis. Transmural pattern and the relative CT density > 2.31 (OR 168.4; 95% CI, 9.76-2906, P<0.001, OR 15.69; 95% CI, 1.07-228, P=0.044) were significantly independent predictors for MVO. For prediction of MVO, transmural pattern and the relative CT value>2.31 showed a high positive predictive value of 100%, and their absence showed a high negative predictive value of 96% (Table).
Conclusions: MDCT immediately after primary PCI may provide promising information for predicting MVO in patients with AMI.
- Computed tomography
- Myocardial infarction
- Magnetic resonance imaging
- Percutaneous coronary intervention
- © 2013 by American Heart Association, Inc.