Safety and accuracy of multidetector row computed tomography for early assessment of residual stenosis of the infarct-related artery and the number of diseased vessels after acute myocardial infarction.
BACKGROUND
Recent studies reveal that contrast-enhanced multidetector row computed tomography (MDCT) is a promising technique for noninvasive visualization of coronary artery stenoses. We investigated the safety and accuracy of MDCT for early assessment of the severity of residual stenosis of the infarct-related artery (IRA) and the number of diseased vessels in patients after acute myocardial infarction (AMI).


RESULTS
Of 146 AMI cases admitted, 72 fit with criteria and underwent 16-slice MDCT (4 +/- 2 days after AMI) with beta-blockers. There were no complications except 1 patient who had from complete atrioventricular block. Results were compared with conventional coronary angiography (CCA) within 3 days. In 55 (73.3%) of 72 patients, all arteries were assessable. In total, the number of assessable arteries was 253 (87.8%), and 35 (12.2%) vessels were nonassessable, mostly because of motion artifacts and extensive calcification. Overall, 84 of the 115 lesions (> or = 50% lumen reduction) were correctly detected by MDCT (sensitivity 73.0%). The accuracy in classifying patients with nonsignificant, single-, or multiple-vessel diseases was 79.1%. The accuracy for residual lesions with >50% stenosis of IRA was 87.5%. There was a good correlation regarding the severity of residual stenosis of the IRA (0%, 1%-49%, 50%-89%, 90%-99%, or occlusion) between MDCT and CCA (Spearman correlation 0.94, P < .001). Lesions with 90% to 99% or occlusion of the IRA were accurately detected or ruled out in 31 of 36 cases (86.1%).


CONCLUSIONS
With appropriate protocol, MDCT is safe and accurate in assessing the severity of IRA and the number of diseased vessels during the first week after AMI. It has the potential to provide triage for early management of patients after AMI.
Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
Kuan-Rau
KR
Chiou
Ming-Ting
MT
Wu
Shih-Hung
SH
Hsiao
Guang-Yuan
GY
Mar
Huay-Ben
HB
Pan
Chien-Fang
CF
Yang
Chun-Peng
CP
Liu
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000368:Aged; D016477:Artifacts; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging; D015897:Comorbidity; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D010100:Oxygen / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D036542:Tomography, Spiral Computed / Q000009:adverse effects
D000319:Adrenergic beta-Antagonists; D008790:Metoprolol; D010100:Oxygen