Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., Saint Louis, MO, 63110, USA.
Int J Cardiovasc Imaging. 2013 Oct;29(7):1485-90. doi: 10.1007/s10554-013-0231-9. Epub 2013 Apr 27.
In the first 8 weeks after percutaneous coronary intervention (PCI), possible negative interactions exist between the cardiac magnetic resonance (CMR) imaging environment and the weakly ferromagnetic material in coronary stents. There are circumstances when CMR would be indicated shortly following PCI, such as acute myocardial infarction (AMI). The purpose of this study is to demonstrate CMR safety shortly following stent PCI in AMI patients. We performed a retrospective analysis of safety data in AMI patients with recently placed coronary artery stents enrolled in a multi-center phase II trial for gadoversetamide. Patients underwent 1.5 T CMR within 16 days of PCI. Vital signs (blood pressure, heart rate, respiratory rate, and body temperature) and ECGs were taken pre-CMR, 1, 2, and 24 h post-CMR. Any major adverse cardiac event (MACE) or other serious adverse events in the first 24 h after MRI were recorded. There were 258 stents in 211 AMI patients. The mean delay to CMR following PCI was 6.5 ± 4 days, with 62 patients (29 %) receiving CMR within 3 days and 132 patients (63 %) within 1 week. Patients showed no significant vital sign changes following CMR. Ten patients (4.7 %) showed mild, transient ECG changes. Within the 24-h follow-up group, 4 patients (1.9 %) had moderate to severe events, including chest pain (1) and elevated cardiac enzymes (1), resolving in 24 h; heart failure (1) and ischemic stroke (1). There were no deaths. This study demonstrates fewer MACE in AMI patients undergoing 1.5 T CMR within 16 days of stent placement in comparison to post-stent event rate reported in the literature. This study adds to the CMR after stent PCI safety profile suggested by previous studies and is the largest and first study that uses multicenter data to assess stent safety following CMR examination.
在经皮冠状动脉介入治疗(PCI)后的头 8 周内,心脏磁共振(CMR)成像环境与冠状动脉支架中的弱铁磁材料之间可能存在负面相互作用。在某些情况下,PCI 后不久就需要进行 CMR,例如急性心肌梗死(AMI)。本研究旨在证明 AMI 患者 PCI 后短期内进行 CMR 的安全性。我们对一项多中心二期临床试验中接受钆喷酸葡胺检查的近期放置冠状动脉支架的 AMI 患者的安全性数据进行了回顾性分析。患者在 PCI 后 16 天内行 1.5T CMR。在 CMR 前、1、2 和 24 小时测量生命体征(血压、心率、呼吸频率和体温)和心电图。记录 MRI 后 24 小时内的任何重大不良心脏事件(MACE)或其他严重不良事件。211 例 AMI 患者共 258 个支架。PCI 后行 CMR 的平均延迟时间为 6.5±4 天,62 例(29%)患者在 3 天内行 CMR,132 例(63%)患者在 1 周内行 CMR。患者在 CMR 后生命体征无明显变化。10 例(4.7%)患者出现轻度、短暂的心电图改变。在 24 小时随访组中,4 例(1.9%)患者发生中度至重度事件,包括胸痛(1 例)和心脏酶升高(1 例),24 小时内缓解;心力衰竭(1 例)和缺血性脑卒中(1 例)。无死亡。与文献报道的支架后事件发生率相比,本研究显示在支架放置后 16 天内行 1.5T CMR 的 AMI 患者的 MACE 较少。本研究增加了先前研究提示的支架后行 CMR 安全性概况,并首次使用多中心数据评估 CMR 检查后支架的安全性。