Early assessment of myocardial viability by the use of delayed enhancement computed tomography after primary percutaneous coronary intervention.
OBJECTIVE
We sought to explore the relationship between established parameters of reperfusion and the extent of myocardial damage measured by the delayed enhancement (DE) of iodinated contrast by multidetector computed tomography (MDCT) immediately after primary percutaneous coronary intervention (PCI).


BACKGROUND
Early detection of myocardial viability should be valuable for risk stratification of patients with reperfused acute myocardial infarction (AMI).


METHODS
Consecutive patients without a history of previous AMI who underwent primary PCI for an ST-segment elevation AMI were examined by DE-MDCT without an additional contrast injection immediately after completion of PCI. No medication was administrated to lower the heart rate. Dose modulation lead to an approximate mean radiation dose of 5.5 mSv.


RESULTS
Thirty patients constituted the study population. Mean age was 61.4 +/- 15.6 years, 24 (80%) were men, and 4 (13%) were diabetic. Although post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 was achieved in all patients, DE was detected in 14 (47%) patients. Age, sex, hypertension, diabetes, smoking history, serum creatinine levels, and pain duration were not associated with the presence of DE. Door-to-balloon time (DE 70.3 +/- 33.6 min vs. non-DE 98.3 +/- 70.7 min, p = 0.19) and lesion crossing time (DE 18.6 +/- 11.4 min vs. non-DE 16.4 +/- 9.6 min, p = 0.58) did not differ between groups. The TIMI myocardial perfusion grade (0 to 1 vs. 2 to 3) after stent implantation and electrocardiogram ST-segment resolution (<50% or >/=50%) were associated with the presence of DE (p = 0.001 and p = 0.02, respectively). Pre-discharge left ventricular ejection fraction was lower in DE than in non-DE patients (44.6 +/- 12.4% vs. 54.1 +/- 10.3%, respectively, p = 0.05). Hospitalization days (DE 5.6 +/- 3.8 vs. non-DE 4.8 +/- 1.0, p = 0.41) and 6-month cardiac events (DE 3 of 14 vs. non-DE 1 of 16, p = 0.22) did not differ between groups.


CONCLUSIONS
Early detection of myocardial viability immediately after primary PCI by the use of DE-MDCT is related to clinical and angiographic parameters of myocardial reperfusion.
Rodriguez-Granillo
Gastón A
GA
Department of Cardiovascular Imaging, Otamendi Hospital, C1115AAB, Buenos Aires, Argentina. grodriguezgranillo@gmail.com
Rosales
Miguel A
MA
Baum
Santiago
S
Rennes
Paola
P
Rodriguez-Pagani
Carlos
C
Curotto
Valeria
V
Fernandez-Pereira
Carlos
C
Llaurado
Claudio
C
Risau
Gustavo
G
Degrossi
Elina
E
Doval
Hernán C
HC
Rodriguez
Alfredo E
AE
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media; D003326:Coronary Circulation; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D009206:Myocardium / Q000201:enzymology / Q000473:pathology*; D009336:Necrosis; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012008:Recurrence; D013318:Stroke Volume; D013997:Time Factors; D014022:Tissue Survival; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D015415:Biomarkers; D003287:Contrast Media; D003402:Creatine Kinase