Abanador-Kamper Nadine, Kamper Lars, Vorpahl Marc, Brinkmann Hilmar, Karamani Vasiliki, Haage Patrick, Seyfarth Melchior
Department of Cardiology Center for Clinical Medicine (ZFKM) Department of Diagnostic and Interventional Radiology, HELIOS University Hospital Wuppertal, University Witten/Herdecke, Germany.
Medicine (Baltimore). 2017 May;96(21):e7004. doi: 10.1097/MD.0000000000007004.
Despite prompt revascularization, some patients with acute myocardial infarction (AMI) develop myocardial scars, which can be visualized by late gadolinium enhancement (LGE) in cardiovascular magnetic resonance imaging (CMR). Our goal was to identify angiographic findings that were predictive for scar development in patients after reperfused AMI.We examined 136 patients after first ST-elevated myocardial infarction by CMR after a median of 4 days (range: 2-7). Patients with manifestation of LGE were matched to patients without LGE by means of age and gender. Clinical follow-up with a combined primary endpoint including myocardial reinfarction, congestive heart failure, stroke, death and development of left ventricular thrombus was reported after 24 months.Patients with manifestation of LGE had a significant longer time of symptom-to-intervention, a higher prevalence of anterior AMI, and more proximal culprit lesions. Furthermore, left ventricular ejection fraction was significantly decreased, and peak values of infarct markers were significantly higher in these patients. Preinterventional thrombolysis in myocardial infarction-0-flow was significantly more frequent in patients with LGE manifestation. The presence of 3-vessel disease (odds ratio 53.99, 95% confidence interval 8.22-354.63, P <.001), a proximal culprit lesion, and high creatine kinase myocardial band (CK-MB) values were identified as independent predictors of LGE. Follow-up demonstrated a higher incidence of clinical events in the group with LGE, with the most common cause of heart failure (38.2% vs 7.4%, P <.001).The extent of angiographic findings in AMI plays a major role in the manifestation of LGE. The presence of a multivessel disease, a proximal culprit lesion, and high values of CK-MB are strong independent predictors for LGE manifestation.
尽管进行了及时的血管重建，但一些急性心肌梗死（AMI）患者仍会形成心肌瘢痕，这在心血管磁共振成像（CMR）中可通过延迟钆增强（LGE）显示出来。我们的目标是确定血管造影结果，以预测再灌注AMI患者的瘢痕形成情况。我们对136例首次发生ST段抬高型心肌梗死的患者进行了CMR检查，检查时间中位数为4天（范围：2 - 7天）。通过年龄和性别将有LGE表现的患者与无LGE表现的患者进行匹配。24个月后报告了包括心肌再梗死、充血性心力衰竭、中风、死亡和左心室血栓形成的联合主要终点的临床随访情况。有LGE表现的患者症状至干预的时间明显更长，前壁AMI的患病率更高，罪犯病变更靠近近端。此外，这些患者的左心室射血分数明显降低，梗死标志物的峰值明显更高。有LGE表现的患者中，介入前心肌梗死溶栓0级血流更为常见。三支血管病变（比值比53.99，95%置信区间8.22 - 354.63，P<0.001）、近端罪犯病变和高肌酸激酶同工酶（CK - MB）值被确定为LGE的独立预测因素。随访显示LGE组临床事件的发生率更高，心力衰竭是最常见的原因（38.2%对7.4%，P<0.001）。AMI血管造影结果的程度在LGE的表现中起主要作用。多支血管病变、近端罪犯病变和CK - MB高值是LGE表现的强有力独立预测因素。
