title: Noninvasive evaluation of coronary reperfusion by CT angiography in patients with STEMI.
abstract: OBJECTIVE
  The aim of this study was to determine whether 64-slice multidetector computed tomography (MDCT) can differentiate coronary reperfusion with Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 from TIMI flow grade ≤ 2 after ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Multidetector computed tomography has become a popular modality for noninvasive coronary artery imaging. Recently, 64-slice MDCT has been applied to evaluate coronary arteries in acute coronary artery disease.
  
  
  METHODS
  The presence or absence of distal reperfusion in infarct-related arteries (IRA) was visualized with 64-slice MDCT during the acute phase in 87 non-high-risk patients after STEMI. To differentiate TIMI flow grade 3 from TIMI flow grade 2, we calculated the computed tomography (CT) number ratio by dividing the CT number of the contrast-enhanced coronary lumen at the most distal IRA by that at the proximal site to the culprit lesion in patients with reperfusion on MDCT. The MDCT findings were compared with TIMI flow grade with invasive coronary angiography (ICA) performed 20 ± 5 min later.
  
  
  RESULTS
  According to ICA, 58 patients had TIMI flow grade 0 or 1, 17 had TIMI flow grade 2, and 12 had TIMI flow grade 3, whereas distal reperfusion was evident on MDCT in 28 of the 29 patients with TIMI flow grade ≥ 2 and absent in 55 of the 58 with TIMI flow grade ≤ 1. The CT number ratio was significantly higher in TIMI flow grade 3 than in TIMI flow grade ≤ 2 (0.64 ± 0.11 vs. 0.37 ± 0.12; p < 0.0001). The sensitivity, specificity, and accuracy of a diagnosis of TIMI flow grade 3 on the basis of a CT number ratio of ≥ 0.54 that was an optimal cutoff value determined by receiver-operator characteristic curve analysis were 92%, 97%, and 97%, respectively.
  
  
  CONCLUSIONS
  Visualization of the IRA by 64-slice MDCT enables noninvasive differentiation of angiographic TIMI flow grade 3 from TIMI flow grade ≤ 2 coronary reperfusion during the acute phase in patients with STEMI.
authors.affiliation: Department of Cardiology, Kagoshima City Hospital, Kagoshima, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamashita
authors.forename: Souki
authors.initials: S
authors.lastname: Lee
authors.forename: Shuichi
authors.initials: S
authors.lastname: Hamasaki
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nishimoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Kajiya
authors.forename: Koichi
authors.initials: K
authors.lastname: Toyonaga
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Arima
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Toda
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ohba
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Otsuji
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed