Teng Yun, Hoshino Masahiro, Kanaji Yoshihisa, Sugiyama Tomoyo, Misawa Toru, 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.
Hellenic J Cardiol. 2024 Jul 15. doi: 10.1016/j.hjc.2024.07.004.
Unrecognized myocardial infarction (UMI) on delayed-enhancement cardiac magnetic resonance imaging (DE-CMR) and coronary computed tomography angiography (CCTA) derived high-risk features provide prognostic information in patients with chronic coronary syndrome (CCS). The study aimed to assess the prognostic value of UMI and predictors of UMI using CCTA in patients with CCS who underwent elective percutaneous coronary intervention (PCI).
This study enrolled 181 patients with CCS who underwent DE-CMR and CCTA before elective PCI. The CCTA-derived predictors of UMI and the association of baseline clinical characteristics, CCTA findings, and CMR-derived factors, including UMI, with MACEs, defined as death, nonfatal myocardial infarction, unplanned late revascularization, hospitalization for congestive heart failure, and stroke, were investigated.
UMI was detected in 57 (31.5%) patients. ROC analysis revealed that the optimal cut-off values of Agatston score and mean peri-coronary fat attenuation index (FAI) for predicting the presence of UMI were 397 and -69.8, respectively. The multivariable logistic regression analysis revealed that left ventricular mass, Agatston score >397, mean FAI >-69.8, positive remodeling of the target lesion, and CCTA-derived stenosis severity were independent predictors of UMI. Kaplan-Meier analysis revealed that patients with UMI were associated with increased risk of MACEs. The Cox proportional hazards analysis showed post-PCI minimum lumen diameter and the presence of UMI were independent predictors of MACEs. The risk of MACEs significantly increased according to the number of four preprocedural CCTA-relevant features of UMI.
Preprocedural comprehensive CCTA analysis may help predict the presence of UMI and provide prognostic information in patients with CCS who underwent PCI.
延迟强化心脏磁共振成像（DE-CMR）检测到的未识别心肌梗死（UMI）以及冠状动脉计算机断层扫描血管造影（CCTA）得出的高危特征可为慢性冠状动脉综合征（CCS）患者提供预后信息。本研究旨在评估UMI的预后价值以及使用CCTA对接受择期经皮冠状动脉介入治疗（PCI）的CCS患者中UMI的预测因素。
本研究纳入了181例在择期PCI前接受DE-CMR和CCTA检查的CCS患者。研究了CCTA得出的UMI预测因素，以及基线临床特征、CCTA结果和包括UMI在内的CMR得出的因素与主要不良心血管事件（MACEs，定义为死亡、非致命性心肌梗死、非计划性晚期血运重建、因充血性心力衰竭住院和中风）之间的关联。
57例（31.5%）患者检测到UMI。ROC分析显示，预测UMI存在的阿加斯顿评分和平均冠状动脉周围脂肪衰减指数（FAI）的最佳截断值分别为397和-69.8。多变量逻辑回归分析显示，左心室质量、阿加斯顿评分>397、平均FAI>-69.8、靶病变阳性重塑以及CCTA得出的狭窄严重程度是UMI的独立预测因素。Kaplan-Meier分析显示，UMI患者发生MACEs的风险增加。Cox比例风险分析显示，PCI后最小管腔直径和UMI的存在是MACEs的独立预测因素。根据UMI的四个术前CCTA相关特征数量，MACEs的风险显著增加。
术前全面的CCTA分析可能有助于预测UMI的存在，并为接受PCI的CCS患者提供预后信息。
