Computer-assisted quantification of myocardial reperfusion after primary percutaneous coronary intervention predicts functional and contrast-enhanced cardiovascular magnetic resonance outcomes in patients with ST-segment elevation myocardial infarction

• Published in: Catheterization and cardiovascular interventions 2011-02, Vol.77 (2), p.174-181
• Main Authors: Gu, Youlan L., Haeck, Joost D.E., Vogelzang, Mathijs, Bilodeau, Luc, Krucoff, Mitchell W., Tijssen, Jan G.P., de Winter, Robbert J., Zijlstra, Felix, Koch, Karel T.
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary; cardiovascular magnetic resonance imaging; computer-assisted myocardial blush grade; Contrast Media; Coronary Angiography; Coronary Circulation; Female; Humans; Linear Models; Magnetic Resonance Imaging; Male; Middle Aged; Multicenter Studies as Topic; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardial Perfusion Imaging - methods; Netherlands; Predictive Value of Tests; primary percutaneous coronary intervention; Radiographic Image Interpretation, Computer-Assisted; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Assessment; Risk Factors; ST-segment elevation myocardial infarction; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.22665

Objective. We investigated whether the Quantitative Blush Evaluator (QuBE) value predicts functional and contrast‐enhanced cardiovascular magnetic resonance (CMR) outcomes at 4–6 months after primary percutaneous coronary intervention (PCI) in patients with ST‐segment elevation myocardial infarction (STEMI). Background. QuBE is a computer‐assisted open source program to quantify myocardial reperfusion. Although a higher QuBE value is associated with improved myocardial reperfusion measures and lower 1‐year mortality, the association with intermediate functional parameters after STEMI has not yet been investigated. Methods. QuBE values were quantified retrospectively on angiograms of patients enrolled in the ancillary CMR study of the proximal embolic protection in acute myocardial infarction and resolution of ST‐elevation trial. QuBE en CMR outcomes were independently assessed by reviewers blinded to clinical data. Results. A higher QuBE value was significantly associated with a smaller left ventricular (LV) end‐diastolic and end‐systolic volume, a higher LV ejection fraction and systolic wall thickening in the infarct area, and a smaller final infarct size and extent of transmural segments (P ≤ 0.008). In a multivariable model, including age, gender, infarct location, time to treatment, history of myocardial infarction, and postprocedural thrombolysis in myocardial infarction flow grade, only the QuBE value and infarct location remained as independent predictors of LV ejection fraction (P = 0.018 for QuBE value). Conclusion. Higher QuBE values are independently associated with improved functional and contrast‐enhanced CMR outcomes including LV ejection fraction at 4–6 months after primary PCI and may therefore aid in identifying high‐risk patients who benefit most from adjunctive therapies sustaining myocardial function after PCI. © 2010 Wiley‐Liss, Inc.