Comparison of magnetic resonance imaging findings in non-ST-segment elevation versus ST-segment elevation myocardial infarction patients undergoing early invasive intervention

Jianqiang Xu, Young Bin Song, Joo Yong Hahn, Sung A. Chang, Sang Chol Lee, Yeon Hyeon Choe, Seung Hyuk Choi, Jin Ho Choi, Sang Hoon Lee, Jae K. Oh, Hyeon Cheol Gwon

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

To define causes and pathological mechanisms underlying differences in clinical outcomes, we compared the findings of contrast-enhanced magnetic resonance imaging (CE-MRI) between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). In 168 patients undergoing early invasive intervention for STEMI (n = 113) and NSTEMI (n = 55), CE-MRI was performed a median of 6 days after the index event. Infarct size was measured on delayed-enhancement imaging, and area at risk (AAR) was quantified on T2-weighted images. The median infarct size was significantly smaller in the NSTEMI group than in the STEMI group (10.7% [5.6-18.1] vs. 19.2% [10.3-30.7], P<0.001). Although there was a trend toward a greater myocardial salvage index ([AAR - infarct size] × 100/AAR) in the NSTEMI group compared to the STEMI group (48.2 [30.4-66.8] vs. 40.5 [24.8-53.5], P = 0.056), myocardial salvage index was similar between the groups in patients with anterior infarction (39.6 [20.0-54.9] vs. 35.5 [23.2-53.4], P = 0.96). The NSTEMI group also had a significantly lower extent of microvascular obstruction and a smaller number of segments with >75% of infarct transmurality relative to the STEMI group (0% [0-0.6] vs. 0.9% [0-2.3], P<0.001 and 3.0 ± 2.3 vs. 4.6 ± 2.9, P = 0.001, respectively). Myocardial hemorrhage was detected less frequently in the NSTEMI group than the STEMI group (22.6% vs. 43.8%, P = 0.029). In the multivariate analysis, baseline Thrombolysis In Myocardial Infarction flow grade 3 and hemorrhagic infarction were closely associated with ST-segment elevation (OR 0.32, 95% CI 0.13-0.81, P = 0.017; OR 5.66, 95% CI 1.77- 18.12, P = 0.003, respectively). In conclusion, in vivo pathophysiological differences revealed by CE-MRI assessment include more favorable infarct size, AAR, myocardial salvage and reperfusion injury in patients with NSTEMI compared to those with STEMI undergoing early invasive intervention.

Original languageEnglish (US)
Pages (from-to)1487-1497
Number of pages11
JournalInternational Journal of Cardiovascular Imaging
Volume28
Issue number6
DOIs
StatePublished - Aug 2012

Keywords

  • Acute myocardial infarction
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Comparison of magnetic resonance imaging findings in non-ST-segment elevation versus ST-segment elevation myocardial infarction patients undergoing early invasive intervention'. Together they form a unique fingerprint.

  • Cite this