Rodriguez-Granillo Gastón A, Rosales Miguel A, Baum Santiago, Rennes Paola, Rodriguez-Pagani Carlos, Curotto Valeria, Fernandez-Pereira Carlos, Llaurado Claudio, Risau Gustavo, Degrossi Elina, Doval Hernán C, Rodriguez Alfredo E
Department of Cardiovascular Imaging, Otamendi Hospital, C1115AAB, Buenos Aires, Argentina.
JACC Cardiovasc Imaging. 2009 Sep;2(9):1072-81. doi: 10.1016/j.jcmg.2009.03.023.
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).
Early detection of myocardial viability should be valuable for risk stratification of patients with reperfused acute myocardial infarction (AMI).
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.
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.
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.
我们试图探讨在直接经皮冠状动脉介入治疗（PCI）后，通过多排螺旋计算机断层扫描（MDCT）对碘化造影剂延迟强化（DE）测量的心肌损伤程度与已确立的再灌注参数之间的关系。
早期检测心肌存活性对于再灌注急性心肌梗死（AMI）患者的危险分层应具有重要价值。
对连续的无既往AMI病史且因ST段抬高型AMI接受直接PCI的患者，在PCI完成后立即通过DE-MDCT进行检查，无需额外注射造影剂。未给予药物降低心率。剂量调制导致平均辐射剂量约为5.5 mSv。
30例患者构成研究人群。平均年龄为61.4±15.6岁，24例（80%）为男性，4例（13%）患有糖尿病。尽管所有患者术后均达到心肌梗死溶栓（TIMI）血流3级，但14例（47%）患者检测到DE。年龄、性别、高血压、糖尿病、吸烟史、血清肌酐水平和疼痛持续时间与DE的存在无关。两组之间的门球时间（DE组70.3±33.6分钟 vs. 无DE组98.3±70.7分钟，p = 0.19）和病变通过时间（DE组18.6±11.4分钟 vs. 无DE组16.4±9.6分钟，p = 0.58）无差异。支架植入后的TIMI心肌灌注分级（0至1级 vs. 2至3级）和心电图ST段回落（<50%或≥50%）与DE的存在相关（分别为p = 0.001和p = 0.02）。出院前左心室射血分数DE组低于无DE组（分别为44.6±12.4% vs. 54.1±10.3%，p = 0.05）。两组之间的住院天数（DE组5.6±3.8天 vs. 无DE组4.8±1.0天，p = 0.41）和6个月心脏事件（DE组14例中有3例 vs. 无DE组16例中有1例，p = 0.22）无差异。
通过使用DE-MDCT在直接PCI后立即早期检测心肌存活性与心肌再灌注的临床和血管造影参数相关。
