Abstract 15487: The Systematic Evaluation of Identifying the Infarct Related Artery Utilizing Cardiac Magnetic Resonance in Patients Presenting With ST-Elevation Myocardial Infarction
Background: Identification of the infarct-related artery (IRA) in patients with STEMI using angiography is often based on the ECG and can be challenging in some clinical situations. 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 late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR).
Methods: Among patients enrolled in the Reduction of infarct Expansion and Ventricular remodeling with Erythropoetin After Large myocardial infarction (REVEAL) trial, 113 of 222 patients randomized who presented with a diagnosis of STEMI completed baseline CMR at 4 +/- 2 days post-PCI. Blinded reviewers interpreted the cardiac catheterization and the CMR, assigning acuity to the infarct region if microvascular obstruction or edema by T2-weighted imaging was present. For the determination of a match between the IRA by cardiac catheterization and the infarct territory on CMR, the segments affected by the IRA as coded according to the 17-segment model on angiography were compared to the segments of hyperenhancement noted on CMR.
Results: A total of 5 (4%) patients were found to have a mismatch between the IRA identified on CMR and angiography. In 4 of the 5 cases, there were multiple infarcts noted on CMR. In addition, 13 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.
Conclusion: This study found that the identification of the IRA by angiography did not match the coronary artery territory of MI as determined by CMR in 4% of patients presenting with STEMI. These data suggest a role for more sophisticated imaging prior to PCI in selected STEMI patients.
Author Disclosures: C.E. Hamo: None. I. Klem: None. S.V. Rao: None. V. Songco: None. S.S. Najjar: None. E.G. Lakatta: None. S.V. Raman: None. R.A. Harrington: Research Grant; Modest; Intramural Research Program, NIA. J.F. Heitner: None.
- © 2015 by American Heart Association, Inc.