Identifying the Infarct-Related Artery in Patients With Non–ST-Segment–Elevation Myocardial Infarction: Insights From Cardiac Magnetic Resonance Imaging

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

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

16 Citations (Web of Science)

Abstract

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.

Original languageEnglish
Article number007305
Number of pages10
JournalCirculation-Cardiovascular Interventions
Volume12
Issue number5
DOIs
Publication statusPublished - May 2019

Keywords

  • ACUTE CORONARY SYNDROMES
  • AMERICAN-COLLEGE
  • BOARD
  • CARDIOLOGY
  • CONTRAST-ENHANCED MRI
  • HEART
  • MULTIVESSEL
  • SOCIETY
  • TRUSTEES TASK-FORCE
  • WOMEN
  • acute coronary syndrome
  • cardiologists
  • heart
  • humans
  • myocardial infarction
  • TRIAL

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