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Comparative Study
. 2019 May;12(5):e007305.
doi: 10.1161/CIRCINTERVENTIONS.118.007305.

Identifying the Infarct-Related Artery in Patients With Non-ST-Segment-Elevation Myocardial Infarction

John F Heitner  1 , Annamalai Senthilkumar  2 , J Kevin Harrison  2 , Igor Klem  2 , Michael H Sketch Jr  2 , Alexandr Ivanov  1 , Carine Hamo  1 , Lowie Van Assche  2 , James White  2 , Jeffrey Washam  2 , Manesh R Patel  2 , Sebastiaan C A M Bekkers  3 , Martijn W Smulders  3 , Terrence J Sacchi  1 , Raymond J Kim  2
Affiliations
Free article
Comparative Study

Identifying the Infarct-Related Artery in Patients With Non-ST-Segment-Elevation Myocardial Infarction

John F Heitner et al. Circ Cardiovasc Interv. 2019 May.
Free article

Abstract

Background: Determining the infarct-related artery (IRA) in non-ST-segment-elevation myocardial infarction (MI) can be challenging. Delayed-enhancement cardiac magnetic resonance (DE-CMR) can accurately identify small MIs. The purpose of this study was to determine whether DE-CMR improves the ability to identify the IRA in patients with non-ST-segment-elevation MI.

Methods and results: In this 3-center, prospective study, we enrolled 114 patients presenting with their first MI. Patients underwent DE-CMR followed by coronary angiography. The interventional cardiologist was blinded to the DE-CMR results. Later, coronary angiography and DE-CMR images were reviewed independently and blindly for identification of the IRA. The pattern of DE-CMR hyperenhancement was also used to determine whether there was a nonischemic pathogenesis for myocardial necrosis. The IRA was not identifiable by coronary angiography in 37% of patients (n=42). In these, the IRA or a new noncoronary artery disease diagnosis was identified by DE-CMR in 60% and 19% of patients, respectively. Even in patients with an IRA determined by coronary angiography, a different IRA or a noncoronary artery disease diagnosis was identified by DE-CMR in 14% and 13%, respectively. Overall, DE-CMR led to a new IRA diagnosis in 31%, a diagnosis of nonischemic pathogenesis in 15%, or either in 46% (95% CI, 37%-55%) of patients. Of 55 patients undergoing revascularization, 27% had revascularization solely to nonculprit coronary artery territories as determined by DE-CMR.

Conclusions: Identification of the IRA by coronary angiography can be challenging in patients with non-ST-segment-elevation MI. In nearly half, DE-CMR may lead to a new IRA diagnosis or elucidate a nonischemic pathogenesis. Revascularization solely of coronary arteries that are believed to be nonculprit arteries by DE-CMR is not uncommon.

Keywords: acute coronary syndrome; cardiologists; heart; humans; myocardial infarction.

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