title: Prognostic value of myocardial contrast delayed enhancement with 64-slice multidetector computed tomography after acute myocardial infarction.
abstract: OBJECTIVE
  This study evaluated the clinical value of myocardial contrast delayed enhancement (DE) with multidetector computed tomography (MDCT) for predicting clinical outcome after acute myocardial infarction (AMI).
  
  
  BACKGROUND
  Although some studies have described the use of MDCT for assessment of myocardial viability after AMI, clinical experience remains limited.
  
  
  METHODS
  In 102 patients with first AMI, 64-slice MDCT without iodine reinjection was performed immediately following successful percutaneous coronary intervention (PCI). We measured the size of myocardial contrast DE on MDCT and compared it with clinical outcome. Primary composite cardiac events were cardiac death or hospitalization for worsening heart failure.
  
  
  RESULTS
  Among the 102 patients (24 ± 10 months follow-up), 19 patients experienced primary composite cardiac events (cardiac death, n = 7; heart failure, n = 12). Kaplan-Meier analysis showed higher risk of cardiac events for patients in the third tertile of myocardial contrast DE size (≥ 36 g) than for those in the other 2 tertiles (p < 0.0001). Multivariable Cox proportional hazards regression analysis indicated that myocardial contrast DE size (adjusted hazard ratio [HR] for tertile 3 vs. 1: 16.1, 95% confidence interval [CI]: 1.45 to 72.4, p = 0.022; HR for tertile 3 vs. 2: 5.06, 95% CI: 1.25 to 22.7, p = 0.039) was a significant independent predictor for cardiac events after adjustment for Thrombolysis In Myocardial Infarction risk score, left ventricular ejection fraction, total defect score on single-photon emission CT with technetium tetrofosmin, and transmural extent of myocardial contrast DE on MDCT.
  
  
  CONCLUSIONS
  Myocardial contrast DE size on MDCT immediately after primary PCI may provide promising information for predicting clinical outcome in patients with AMI.
authors.affiliation: Cardiovascular Division, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan. asato@md.tsukuba.ac.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nozato
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hikita
authors.forename: Daiki
authors.initials: D
authors.lastname: Akiyama
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Nishina
authors.forename: Tomoya
authors.initials: T
authors.lastname: Hoshi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Aihara
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kakefuda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Watabe
authors.forename: Michiaki
authors.initials: M
authors.lastname: Hiroe
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods*
chemical_list: D003287:Contrast Media