Early Assessment of Myocardial Viability by the Use of Delayed Enhancement Computed Tomography After Primary Percutaneous Coronary Intervention

• Published in: JACC. Cardiovascular imaging 2009-09, Vol.2 (9), p.1072-1081
• Main Authors: Rodriguez-Granillo, Gastón A., MD, PhD, Rosales, Miguel A., MD, Baum, Santiago, MD, Rennes, Paola, MD, Rodriguez-Pagani, Carlos, MD, Curotto, Valeria, MD, Fernandez-Pereira, Carlos, MD, Llaurado, Claudio, BSc, Risau, Gustavo, MD, Degrossi, Elina, MD, Doval, Hernán C., MD, PhD, Rodriguez, Alfredo E., MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - adverse effects; Biomarkers - blood; Cardiovascular; Contrast Media; Coronary Circulation; Creatine Kinase - blood; Electrocardiography; Female; Humans; Length of Stay; Male; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardial Reperfusion Injury - diagnostic imaging; Myocardial Reperfusion Injury - etiology; Myocardial Reperfusion Injury - physiopathology; Myocardium - enzymology; Myocardium - pathology; Necrosis; Predictive Value of Tests; Recovery of Function; Recurrence; Stroke Volume; Time Factors; Tissue Survival; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Treatment Outcome; Ventricular Function, Left
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2009.03.023

Objectives 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 (