title: Comparison of magnetic resonance imaging findings in non-ST-segment elevation versus ST-segment elevation myocardial infarction patients undergoing early invasive intervention.
abstract: To define causes and pathological mechanisms underlying differences in clinical outcomes, we compared the findings of contrast-enhanced magnetic resonance imaging (CE-MRI) between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). In 168 patients undergoing early invasive intervention for STEMI (n = 113) and NSTEMI (n = 55), CE-MRI was performed a median of 6 days after the index event. Infarct size was measured on delayed-enhancement imaging, and area at risk (AAR) was quantified on T2-weighted images. The median infarct size was significantly smaller in the NSTEMI group than in the STEMI group (10.7% [5.6-18.1] vs. 19.2% [10.3-30.7], P < 0.001). Although there was a trend toward a greater myocardial salvage index ([AAR - infarct size] × 100/AAR) in the NSTEMI group compared to the STEMI group (48.2 [30.4-66.8] vs. 40.5 [24.8-53.5], P = 0.056), myocardial salvage index was similar between the groups in patients with anterior infarction (39.6 [20.0-54.9] vs. 35.5 [23.2-53.4], P = 0.96). The NSTEMI group also had a significantly lower extent of microvascular obstruction and a smaller number of segments with >75% of infarct transmurality relative to the STEMI group (0% [0-0.6] vs. 0.9% [0-2.3], P < 0.001 and 3.0 ± 2.3 vs. 4.6 ± 2.9, P = 0.001, respectively). Myocardial hemorrhage was detected less frequently in the NSTEMI group than the STEMI group (22.6% vs. 43.8%, P = 0.029). In the multivariate analysis, baseline Thrombolysis In Myocardial Infarction flow grade 3 and hemorrhagic infarction were closely associated with ST-segment elevation (OR 0.32, 95% CI 0.13-0.81, P = 0.017; OR 5.66, 95% CI 1.77-18.12, P = 0.003, respectively). In conclusion, in vivo pathophysiological differences revealed by CE-MRI assessment include more favorable infarct size, AAR, myocardial salvage and reperfusion injury in patients with NSTEMI compared to those with STEMI undergoing early invasive intervention.
authors.affiliation: Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
authors.forename: Jianqiang
authors.initials: J
authors.lastname: Xu
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.forename: Sung-A
authors.initials: SA
authors.lastname: Chang
authors.forename: Sang-Chol
authors.initials: SC
authors.lastname: Lee
authors.forename: Yeon Hyeon
authors.initials: YH
authors.lastname: Choe
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Choi
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography; D003326:Coronary Circulation; D005260:Female; D019786:Gadolinium DTPA; D006470:Hemorrhage / Q000175:diagnosis; D006801:Humans; D016015:Logistic Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis / Q000209:etiology; D009206:Myocardium / Q000473:pathology*; D054318:No-Reflow Phenomenon / Q000175:diagnosis / Q000209:etiology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014022:Tissue Survival; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
references.citation: Heart. 2000 Mar;83(3):361-6
references.pmid: 10677422
references.citation: Circulation. 1994 Mar;89(3):1109-17
references.pmid: 8124797
references.citation: Eur Heart J. 2007 Jun;28(12):1409-17
references.pmid: 17412730
references.citation: J Cardiovasc Magn Reson. 2008 Oct 25;10:47
references.pmid: 18950527
references.citation: JACC Cardiovasc Imaging. 2010 May;3(5):491-500
references.pmid: 20466344
references.citation: Circ Cardiovasc Imaging. 2010 Sep;3(5):527-35
references.pmid: 20631034
references.citation: Eur Heart J. 2011 Feb;32(3):284-93
references.pmid: 21112897
references.citation: Heart. 2008 Jun;94(6):730-6
references.pmid: 18070953
references.citation: Eur Heart J. 2010 Nov;31(21):2660-8
references.pmid: 20675660
references.citation: J Am Coll Cardiol. 2004 Jun 16;43(12):2253-9
references.pmid: 15193689
references.citation: Eur J Radiol. 2008 May;66(2):292-9
references.pmid: 17686598
references.citation: Circulation. 2000 May 23;101(20):2368-74
references.pmid: 10821812
references.citation: Catheter Cardiovasc Interv. 2010 Oct 1;76(4):502-10
references.pmid: 20882653
references.citation: J Am Coll Cardiol. 2010 Jun 1;55(22):2470-9
references.pmid: 20510214
references.citation: Korean Circ J. 2011 Jun;41(6):304-7
references.pmid: 21779282
references.citation: Int J Cardiol. 2011 Oct 6;152(1):70-7
references.pmid: 20684999
references.citation: Heart. 2011 Mar;97(6):453-9
references.pmid: 21051455
references.citation: Heart. 2010 Dec;96(23):1885-91
references.pmid: 20965977
references.citation: Circulation. 1998 Jun 16;97(23):2302-6
references.pmid: 9639373
references.citation: J Am Coll Cardiol. 2010 Jun 1;55(22):2480-8
references.pmid: 20510215
references.citation: Clin Cardiol. 2009 Jun;32(6):321-6
references.pmid: 19569068
references.citation: Korean Circ J. 2010 Dec;40(12):639-44
references.pmid: 21267386
references.citation: Am J Cardiol. 2010 Nov 15;106(10):1397-403
references.pmid: 21059427
references.citation: Am J Cardiol. 2006 Oct 15;98(8):1033-40
references.pmid: 17027566
references.citation: Am Heart J. 2007 Apr;153(4):665.e1-8
references.pmid: 17383309
references.citation: Am J Cardiol. 2007 Jul 15;100(2):190-5
references.pmid: 17631068
references.citation: Am J Cardiol. 2006 Aug 1;98(3):331-7
references.pmid: 16860018
references.citation: JACC Cardiovasc Imaging. 2010 Jan;3(1):45-51
references.pmid: 20129530
references.citation: Circulation. 2002 Jan 29;105(4):539-42
references.pmid: 11815441