Multidetector row computed tomography can identify and characterize the occlusive culprit lesions in patients early (within 24 hours) after acute myocardial infarction.
BACKGROUND
The reliable noninvasive assessment of occluded disrupted plaques and thromboses in culprit vessels could constitute an important step forward in risk stratification of patients early after acute myocardial infarction (AMI). However, noninvasive identification of patency of culprit vessels remains a challenging issue. This prospective study was designed to identify the occluded culprit vessels by multidetector row computed tomography (MDCT) and to compare the stenotic and occlusive culprit lesions by MDCT in patients early (within 24 hours) after AMI.


METHODS
We enrolled 62 patients with first Q-wave AMI (54 males). Multidetector row computed tomography was performed 16.5 +/- 7.1 hours after the onset of chest pain without any complication. Coronary angiography was done within 6 hours after MDCT. Patients were divided into 2 groups according to angiographic findings: stenotic group (35 patients) and occluded group (27 patients). The following MDCT data were collected: luminal artery stenosis, remodeling index, plaque burden, and lesion attenuation.


RESULTS
Compared to coronary angiography, MDCT detected occluded culprit vessels with sensitivity, specificity, negative predict value, and positive predict value of 92.6%, 88.6%, 93.9%, and 86.2%, respectively. Compared with the stenotic group, culprit lesions in the occlusive group had significantly longer length (18.9 +/- 9.7 vs 11.9 +/- 6.2 mm; P = .024) and higher MDCT lesion attenuation (38.8 +/- 15.6 vs 29.2 +/- 12.9 Hounsfield unit; P = .008). Multidetector row computed tomography attenuation was negatively correlated with thrombolysis in myocardial infarction flow (Spearman rho = -0.46; P < .001).


CONCLUSIONS
Multidetector row computed tomography could accurately and safely identify occluded culprit lesions in patients early after AMI, providing important information to aid in risk stratification.
Huang
Wei-Chun
WC
Cardiovascular Medical Center, Kaohsiung, Taiwan, Republic of China.
Chiou
Kuan-Rau
KR
Liu
Chun-Peng
CP
Lin
Shih-Kai
SK
Huang
Yi-Luan
YL
Mar
Guang-Yuan
GY
Lin
Shoa-Lin
SL
Wu
Ming-Ting
MT
D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*