Department of Radiology and Neuroradiology, University Medical Center Schleswig Holstein, Campus Kiel, Arnold-Heller-Street 3, 24105, Kiel, Germany.
Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig Holstein, Kiel, Germany.
Sci Rep. 2024 Oct 18;14(1):24456. doi: 10.1038/s41598-024-75499-7.
Emergency computed tomography (CT) often does not allow for comprehensive coronary artery assessment. However, CT may reveal pathological myocardial hypoperfusion suggestive of acute myocardial infarction (AMI), especially in patients presenting with a different diagnostic hypothesis. CT hypoperfusion is known to be associated with myocardial infarction, however the diagnostic value of CT hypoperfusion for the detection of AMI is still not well evaluated. This was a single-centre retrospective study including patients who underwent invasive coronary angiography (ICA) due to suspected AMI based on incidental perfusion defects upon emergency CT imaging between 2018 and 2023. A total of 22 patients (mean age 66.3 ± 10.8 years, 11 female) were included in this analysis. The diagnosis of AMI was established in all cases leading to ICA. Culprit coronary artery lesions with an indication of percutaneous coronary intervention were detected in all patients who underwent ICA. Spearmann correlation for hypoperfused segments on CT imaging and the corresponding vascular territory upon ICA was significantly substantial (ρ = 0.73, p = < 0.001). The higher the number of affected myocardial segments, the faster ICA was initiated. Mean time between the suspicion of AMI on CT imaging and ICA was 196 (29-4044) minutes. Myocardial hypoperfusion on emergency CT imaging should be considered as AMI until proven otherwise, independent of the clinical scenario leading to performance of CT imaging and whether imaging was performed for the exclusion of non-cardiac pathologies. Early initiation of further diagnostic workup may potentially avoid delays to invasive treatment and reduce the CT-to-catheter-time. Our study explicitly underlines that myocardial hypoperfusion upon contrast enhanced CT imaging needs to be considered as sign of acute myocardial infarction and indicates targeted clinical workup to rule out this diagnosis and to shorten the timeframe from imaging diagnosis to interventional treatment.
急诊计算机断层扫描（CT）通常无法全面评估冠状动脉。然而，CT 可能会显示病理性心肌低灌注，提示急性心肌梗死（AMI），尤其是在出现不同诊断假设的患者中。已知 CT 低灌注与心肌梗死有关，但 CT 低灌注对 AMI 的诊断价值仍未得到很好的评估。这是一项单中心回顾性研究，纳入了 2018 年至 2023 年间因急诊 CT 影像显示偶然灌注缺损而疑似 AMI 而行有创冠状动脉造影（ICA）的患者。共有 22 名患者（平均年龄 66.3±10.8 岁，11 名女性）纳入本分析。所有患者均因 AMI 导致 ICA 而建立 AMI 诊断。所有行 ICA 的患者均发现有指示经皮冠状动脉介入治疗的罪犯冠状动脉病变。CT 影像上低灌注节段与 ICA 相应血管区域之间的 Spearman 相关系数显著（ρ=0.73，p<0.001）。受影响的心肌节段越多，ICA 开始得越快。从 CT 影像上怀疑 AMI 到 ICA 的平均时间为 196（29-4044）分钟。在排除非心脏病变的情况下，应将急诊 CT 影像上的心肌低灌注视为 AMI，而不考虑导致 CT 成像的临床情况以及成像是否用于排除非心脏病变。尽早启动进一步的诊断性检查可能有助于避免延迟介入治疗，并缩短 CT 至导管时间。我们的研究明确强调，对比增强 CT 影像上的心肌低灌注需要视为急性心肌梗死的征象，并指示进行有针对性的临床检查以排除该诊断，并缩短从影像诊断到介入治疗的时间框架。
