Hoshino Masahiro, Sugiyama Tomoyo, Kanaji Yoshihisa, Hada Masahiro, Nagamine Tatsuhiro, Nogami Kai, Ueno Hiroki, Sayama Kodai, Matsuda Kazuki, Yonetsu Taishi, Sasano Tetsuo, Kakuta Tsunekazu
Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan.
Int J Cardiovasc Imaging. 2023 Oct;39(10):2051-2061. doi: 10.1007/s10554-023-02903-0. Epub 2023 Jul 24.
Unrecognized myocardial infarction (UMI) detected by cardiac magnetic resonance (CMR) imaging is associated with adverse outcomes in patients with acute and chronic coronary syndrome. This study aimed to assess the predictors of optical coherence tomography (OCT) and coronary computed tomography angiography (CCTA) findings for non-infarct-related (non-IR) territory UMI in patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS).
We investigated 69 patients with a first clinical episode of NSTE-ACS who underwent pre-percutaneous coronary intervention (PCI) 320-slice CCTA, uncomplicated urgent PCI with OCT assessment within 24 h of admission, and post-PCI CMR. UMI was assessed using late gadolinium enhancement to identify regions of hyperenhancement with an ischemic distribution pattern in non-IR territories.
Non-IR UMI was detected in 11 patients (15.9%). Lower ejection fraction, higher Gensini score, higher Agatston score, high pericoronary adipose tissue attenuation (PCATA), OCT-defined culprit lesion plaque rupture, and OCT-defined culprit lesion cholesterol crystal were significantly associated with the presence of non-IR UMI. On dividing the total cohort was divided into five groups according to the numbers of two OCT-derived risk factors and two CCTA-derived risk factors, the frequency of non-IR UMI frequency significantly increased according to the number of these relevant risk features (p < 0.001). Patients with all of the non-IR UMI risk factors showed 50% prevalence of non-IR UMI, compared with 2.2% of patients with low risk factors (≤ 2).
Integrated CCTA and culprit lesion OCT assessment may help identify the presence of non-IR UMI, potentially providing prognostic information in patients with first NSTE-ACS episode.
心脏磁共振成像（CMR）检测到的未识别心肌梗死（UMI）与急性和慢性冠状动脉综合征患者的不良结局相关。本研究旨在评估光学相干断层扫描（OCT）和冠状动脉计算机断层扫描血管造影（CCTA）结果对非ST段抬高急性冠状动脉综合征（NSTE-ACS）患者非梗死相关（non-IR）区域UMI的预测因素。
我们调查了69例首次发生NSTE-ACS临床事件的患者，这些患者在经皮冠状动脉介入治疗（PCI）前接受了320层CCTA检查，在入院后24小时内进行了无并发症的紧急PCI并进行了OCT评估，以及PCI后CMR检查。使用延迟钆增强评估UMI，以识别non-IR区域具有缺血分布模式的高增强区域。
11例患者（15.9%）检测到non-IR UMI。较低的射血分数、较高的Gensini评分、较高的Agatston评分、较高的冠状动脉周围脂肪组织衰减（PCATA）、OCT定义罪犯病变斑块破裂和OCT定义罪犯病变胆固醇结晶与non-IR UMI的存在显著相关。根据两个OCT衍生危险因素和两个CCTA衍生危险因素将总队列分为五组后，non-IR UMI频率根据这些相关风险特征的数量显著增加（p<0.001）。所有non-IR UMI危险因素的患者中non-IR UMI患病率为50%，而低危险因素（≤2个）患者为2.2%。
综合CCTA和罪犯病变OCT评估可能有助于识别non-IR UMI的存在，潜在地为首次发生NSTE-ACS事件的患者提供预后信息。
