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The International Journal of Cardiovascular Imaging

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24-07-2023 | Myocardial Infarction | Original Paper

Multimodality coronary imaging to predict non-culprit territory unrecognized myocardial infarction in Non-ST-Elevation acute coronary syndrome

Authors: Masahiro Hoshino, Tomoyo Sugiyama, Yoshihisa Kanaji, Masahiro Hada, Tatsuhiro Nagamine, Kai Nogami, Hiroki Ueno, Kodai Sayama, Kazuki Matsuda, Taishi Yonetsu, Tetsuo Sasano, Tsunekazu Kakuta

Published in: The International Journal of Cardiovascular Imaging | Issue 10/2023

Abstract

Purpose: 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). Methods: 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. Results: 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). Conclusions: 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.

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Title: Multimodality coronary imaging to predict non-culprit territory unrecognized myocardial infarction in Non-ST-Elevation acute coronary syndrome
Authors: Masahiro Hoshino
Tomoyo Sugiyama
Yoshihisa Kanaji
Masahiro Hada
Tatsuhiro Nagamine
Kai Nogami
Hiroki Ueno
Kodai Sayama
Kazuki Matsuda
Taishi Yonetsu
Tetsuo Sasano
Tsunekazu Kakuta
Publication date: 24-07-2023
Publisher: Springer Netherlands
Keywords: Myocardial Infarction
Acute Coronary Syndrome
Published in: The International Journal of Cardiovascular Imaging / Issue 10/2023
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-023-02903-0

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Multimodality coronary imaging to predict non-culprit territory unrecognized myocardial infarction in Non-ST-Elevation acute coronary syndrome

Abstract

Keynote webinar | Spotlight on medication adherence

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Abstract

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