Impact of Multiple Myocardial Scars Detected by CMR in Patients Following STEMI
| Autor: | Thomas Engstrøm, Mikkel Malby Schoos, Lars Køber, Christoffer Göransson, Kathrine Ekström, Adam Ali Ghotbi, Lars Nepper-Christensen, Niels Vejlstrup, Henning Kelbæk, Dan E. Høfsten, Litten Bertelsen, Steffen Helqvist, Kiril Aleksov Ahtarovski, Jacob Lønborg, Kasper Kyhl |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Denmark medicine.medical_treatment Contrast Media Scars 030204 cardiovascular system & hematology Revascularization Risk Assessment Culprit 030218 nuclear medicine & medical imaging Cicatrix 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Predictive Value of Tests Risk Factors Interquartile range Internal medicine Humans Medicine Radiology Nuclear Medicine and imaging cardiovascular diseases Myocardial infarction Aged Heart Failure business.industry Incidence Myocardium Percutaneous coronary intervention Middle Aged medicine.disease Magnetic Resonance Imaging Hospitalization Treatment Outcome Heart failure Conventional PCI Cardiology ST Elevation Myocardial Infarction Female medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | JACC: Cardiovascular Imaging. 12:2168-2178 |
| ISSN: | 1936-878X |
| Popis: | Objectives This study investigated the incidence and long-term prognostic importance of multiple myocardial scars in cardiac magnetic resonance (CMR) in a large contemporary cohort of patients with ST-segment elevation myocardial infarction (STEMI). Background Patients presenting with STEMI may have multiple infarctions/scars caused by multiple culprit lesions, previous myocardial infarction (MI) or procedure-related MI due to nonculprit interventions. However, the incidence, long-term prognosis, and distribution of causes of multiple myocardial scars remain unknown. Methods CMR was performed in 704 patients with STEMI 1 day after primary percutaneous coronary intervention (PCI) and again 3 months later. Myocardial scars were assessed by late gadolinium enhancement (LGE). T2-weighted technique was used to differentiate acute from chronic infarctions. The presence of multiple scars was defined as scars located in different coronary territories. The combined endpoints of all-cause mortality and hospitalization for heart failure were assessed at 39 months (interquartile range [IQR]: 31 to 48 months). Results At 3 months, 59 patients (8.4%) had multiple scars. Of these, multiple culprits in STEMI were detected in 7 patients (1%), and development of a second nonculprit scar at follow-up occurred in 10 patients (1.4%). The most frequent cause of multiple scars was a chronic scar in the nonculprit myocardium. The presence of multiple scars was independently associated with an increased risk of all-cause mortality and hospitalization for heart failure (hazard ratio: 2.7; 95% confidence interval: 1.1 to 6.8; p = 0.037). Conclusions Multiple scars were present in 8.4% of patients with STEMI and were independently associated with an increased risk of long-term morbidity and mortality. The presence of multiple myocardial scars on CMR may serve as a useful tool in risk stratification of patients following STEMI. (DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction [DANAMI-3]; NCT01435408) (Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization [PRIMULTI]; NCT01960933) |
| Databáze: | OpenAIRE |
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