title: The Systematic Evaluation of Identifying the Infarct Related Artery Utilizing Cardiac Magnetic Resonance in Patients Presenting with ST-Elevation Myocardial Infarction.
abstract: BACKGROUND
  Identification of the infarct-related artery (IRA) in patients with STEMI using coronary angiography (CA) is often based on the ECG and can be challenging in patients with severe multi-vessel disease. The current study aimed to determine how often percutaneous intervention (PCI) is performed in a coronary artery different from the artery supplying the territory of acute infarction on cardiac magnetic resonance imaging (CMR).
  
  
  METHODS
  We evaluated 113 patients from the Reduction of infarct Expansion and Ventricular remodeling with Erythropoetin After Large myocardial infarction (REVEAL) trial, who underwent CMR within 4±2 days of revascularization. Blinded reviewers interpreted CA to determine the IRA and CMR to determine the location of infarction on a 17-segment model. In patients with multiple infarcts on CMR, acuity was determined with T2-weighted imaging and/or evidence of microvascular obstruction.
  
  
  RESULTS
  A total of 5 (4%) patients were found to have a mismatch between the IRA identified on CMR and CA. In 4/5 cases, there were multiple infarcts noted on CMR. Thirteen patients (11.5%) had multiple infarcts in separate territories on CMR with 4 patients (3.5%) having multiple acute infarcts and 9 patients (8%) having both acute and chronic infarcts.
  
  
  CONCLUSIONS
  In this select population of patients, the identification of the IRA by CA was incorrect in 4% of patients presenting with STEMI. Four patients with a mismatch had an acute infarction in more than one coronary artery territory on CMR. The role of CMR in patients presenting with STEMI with multi-vessel disease on CA deserves further investigation.
authors.affiliation: Department of Medicine, Stony Brook University Hospital, Stony Brook New York, United States of America.
authors.forename: Carine E
authors.initials: CE
authors.lastname: Hamo
authors.affiliation: The Duke Clinical Research Institute, Durham, North Carolina, United States of America.
authors.forename: Igor
authors.initials: I
authors.lastname: Klem
authors.affiliation: The Duke Clinical Research Institute, Durham, North Carolina, United States of America.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.affiliation: Division of Cardiology, New York Methodist Hospital, Brooklyn, New York, United States of America.
authors.forename: Vincent
authors.initials: V
authors.lastname: Songco
authors.affiliation: MedStar Health Research Institute, Washington, DC, United States of America.|Intramural Research Program, National Institute of Aging, the National Institute of Health, Baltimore, Maryland, United States of America.
authors.forename: Samer
authors.initials: S
authors.lastname: Najjar
authors.affiliation: Intramural Research Program, National Institute of Aging, the National Institute of Health, Baltimore, Maryland, United States of America.
authors.forename: Edward G
authors.initials: EG
authors.lastname: Lakatta
authors.affiliation: Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio, United States of America.
authors.forename: Subha V
authors.initials: SV
authors.lastname: Raman
authors.affiliation: Department of Medicine, Stanford University, Palo Alto, California, United States of America.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.affiliation: Division of Cardiology, New York Methodist Hospital, Brooklyn, New York, United States of America.
authors.forename: John F
authors.initials: JF
authors.lastname: Heitner
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D016032:Randomized Controlled Trials as Topic