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

Gastón A. Rodriguez-Granillo, MD, PhD^_*,,_*, Miguel A. Rosales, MD^_*, Santiago Baum, MD, Paola Rennes, MD, Carlos Rodriguez-Pagani, MD, Valeria Curotto, MD, Carlos Fernandez-Pereira, MD, Claudio Llaurado, BSc, Gustavo Risau, MD, Elina Degrossi, MD^_*, Hernán C. Doval, MD, PhD, Alfredo E. Rodriguez, MD, PhD^_*,

^_* Department of Cardiovascular Imaging, Otamendi Hospital, Buenos Aires, Argentina
Department of Cardiology, Otamendi Hospital, Buenos Aires, Argentina
Department of Interventional Cardiology, Otamendi Hospital, Buenos Aires, Argentina
Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina

^_* Reprint requests and correspondence: Dr. Gastón A. Rodriguez-Granillo, Department of Cardiovascular Imaging, Otamendi Hospital, Azcuenaga 870 (C1115AAB), Buenos Aires, Argentina (Email: grodriguezgranillo{at}gmail.com).

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 (<50% or 50%) were associated with the presence of DE (p = 0.001 and p = 0.02, respectively). Pre-discharge left ventricular ejection fraction was lower in DE than in non-DE patients (44.6 ± 12.4% vs. 54.1 ± 10.3%, respectively, p = 0.05). Hospitalization days (DE 5.6 ± 3.8 vs. non-DE 4.8 ± 1.0, p = 0.41) and 6-month cardiac events (DE 3 of 14 vs. non-DE 1 of 16, p = 0.22) did not differ between groups.

Conclusions: Early detection of myocardial viability immediately after primary PCI by the use of DE-MDCT is related to clinical and angiographic parameters of myocardial reperfusion.

Key Words: myocardial infarction • risk assessment • infarct extension • microvascular perfusion

Abbreviations and Acronyms   AMI = acute myocardial infarction   DE = delayed enhancement   DTB = door-to-balloon time   LV = left ventricle   LVEF = left ventricular ejection fraction   MDCT = multidetector computed tomography   PCI = percutaneous coronary intervention   STEMI = ST-elevation acute myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction   TMPG = Thrombolysis In Myocardial Infarction myocardial perfusion grade

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