Prognostic value of myocardial contrast delayed enhancement with 64-slice multidetector computed tomography after acute myocardial infarction

Abstract

Objectives: 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.