Author + information
- Received September 13, 2018
- Revision received January 16, 2019
- Accepted January 30, 2019
- Published online April 17, 2019.
- Kathrine Ekström, MDa,∗ (, )@kathrineekstrom,
- Lars Nepper-Christensen, MDa,
- Kiril A. Ahtarovski, MD, PhDa,
- Kasper Kyhl, MD, PhDa,
- Christoffer Göransson, MDa,
- Litten Bertelsen, MDa,
- Adam A. Ghotbi, MD, PhDa,
- Henning Kelbæk, MD, DMScb,
- Steffen Helqvist, MD, DMSca,
- Dan E. Høfsten, MD, PhDa,
- Lars Køber, MD, PhD, DMSca,
- Mikkel M. Schoos, MD, PhDa,
- Niels Vejlstrup, MD, PhDa,
- Jacob Lønborg, MD, PhD, DMSca and
- Thomas Engstrøm, MD, PhD, DMSca,c
- aDepartment of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark
- bDepartment of Cardiology, Zealand University Hospital, Roskilde, Denmark
- cDepartment of Cardiology, Lund University Hospital, Lund, Sweden
- ↵∗Address for correspondence:
Dr. Kathrine Ekström, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Objectives This study investigated the incidence and long-term prognostic importance of multiple myocardial scars in cardiac magnetic resonance (CMR) in a large contemporary cohort of patients with ST-segment elevation myocardial infarction (STEMI).
Background Patients presenting with STEMI may have multiple infarctions/scars caused by multiple culprit lesions, previous myocardial infarction (MI) or procedure-related MI due to nonculprit interventions. However, the incidence, long-term prognosis, and distribution of causes of multiple myocardial scars remain unknown.
Methods CMR was performed in 704 patients with STEMI 1 day after primary percutaneous coronary intervention (PCI) and again 3 months later. Myocardial scars were assessed by late gadolinium enhancement (LGE). T2-weighted technique was used to differentiate acute from chronic infarctions. The presence of multiple scars was defined as scars located in different coronary territories. The combined endpoints of all-cause mortality and hospitalization for heart failure were assessed at 39 months (interquartile range [IQR]: 31 to 48 months).
Results At 3 months, 59 patients (8.4%) had multiple scars. Of these, multiple culprits in STEMI were detected in 7 patients (1%), and development of a second nonculprit scar at follow-up occurred in 10 patients (1.4%). The most frequent cause of multiple scars was a chronic scar in the nonculprit myocardium. The presence of multiple scars was independently associated with an increased risk of all-cause mortality and hospitalization for heart failure (hazard ratio: 2.7; 95% confidence interval: 1.1 to 6.8; p = 0.037).
Conclusions Multiple scars were present in 8.4% of patients with STEMI and were independently associated with an increased risk of long-term morbidity and mortality. The presence of multiple myocardial scars on CMR may serve as a useful tool in risk stratification of patients following STEMI. (DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction [DANAMI-3]; NCT01435408) (Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization [PRIMULTI]; NCT01960933)
- cardiac magnetic resonance
- late gadolinium enhancement
- multiple myocardial infarctions
- ST-segment elevation myocardial infarction
The DANAMI-3 trial was funded by Danish Agency for Science, Technology, and Innovation and Danish Council for Strategic Research EDITORS grant 09-066994. Dr. Køber has received funding from Danish Research Foundation. Dr. Engstrøm has received personal fees from Boston Scientific, Abbott, Bayer, Novo Nordisk, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 13, 2018.
- Revision received January 16, 2019.
- Accepted January 30, 2019.
- 2019 American College of Cardiology Foundation
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