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Identifying the Infarct-Related Artery in Patients With Non–ST-Segment–Elevation Myocardial Infarction

2019; Lippincott Williams & Wilkins; Volume: 12; Issue: 5 Linguagem: Inglês

10.1161/circinterventions.118.007305

1941-7632

John F. Heitner, Annamalai Senthilkumar, J. Kevin Harrison, Igor Klem, Michael H. Sketch, Alexandr Ivanov, Carine E. Hamo, Lowie Van Assche, James B. White, Jeffrey B. Washam, Manesh R. Patel, Sebastiaan C.A.M. Bekkers, Martijn W. Smulders, Terrence J. Sacchi, Raymond J. Kim,

Coronary Interventions and Diagnostics

Background: Determining the infarct-related artery (IRA) in non–ST-segment–elevation myocardial infarction (MI) can be challenging. Delayed-enhancement cardiac magnetic resonance (DE-CMR) can accurately identify small MIs. The purpose of this study was to determine whether DE-CMR improves the ability to identify the IRA in patients with non–ST-segment–elevation MI. Methods and Results: In this 3-center, prospective study, we enrolled 114 patients presenting with their first MI. Patients underwent DE-CMR followed by coronary angiography. The interventional cardiologist was blinded to the DE-CMR results. Later, coronary angiography and DE-CMR images were reviewed independently and blindly for identification of the IRA. The pattern of DE-CMR hyperenhancement was also used to determine whether there was a nonischemic pathogenesis for myocardial necrosis. The IRA was not identifiable by coronary angiography in 37% of patients (n=42). In these, the IRA or a new noncoronary artery disease diagnosis was identified by DE-CMR in 60% and 19% of patients, respectively. Even in patients with an IRA determined by coronary angiography, a different IRA or a noncoronary artery disease diagnosis was identified by DE-CMR in 14% and 13%, respectively. Overall, DE-CMR led to a new IRA diagnosis in 31%, a diagnosis of nonischemic pathogenesis in 15%, or either in 46% (95% CI, 37%–55%) of patients. Of 55 patients undergoing revascularization, 27% had revascularization solely to nonculprit coronary artery territories as determined by DE-CMR. Conclusions: Identification of the IRA by coronary angiography can be challenging in patients with non–ST-segment–elevation MI. In nearly half, DE-CMR may lead to a new IRA diagnosis or elucidate a nonischemic pathogenesis. Revascularization solely of coronary arteries that are believed to be nonculprit arteries by DE-CMR is not uncommon.