Coronary Computed Tomography Angiographic Predictors of Non-culprit Territory Unrecognized Myocardial Infarction Assessed by Cardiac Magnetic Resonance in Non-ST-elevation Acute Coronary Syndrome
ObjectivesThis study sought to assess the predictors of coronary computed tomography angiographic findings for non-infarct-related (non-IR) territory unrecognized myocardial infarction (UMI) in patients with a first episode of non-ST-elevation acute coronary syndrome (NSTE-ACS).BackgroundUMI detecte...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-01-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2021.825523/full |
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| author | Kazuki Matsuda Masahiro Hoshino Yoshihisa Kanaji Tomoyo Sugiyama Toru Misawa Masahiro Hada Tatsuhiro Nagamine Kai Nogami Kodai Sayama Yun Teng Hiroki Ueno Taishi Yonetsu Tetsuo Sasano Tsunekazu Kakuta |
| author_facet | Kazuki Matsuda Masahiro Hoshino Yoshihisa Kanaji Tomoyo Sugiyama Toru Misawa Masahiro Hada Tatsuhiro Nagamine Kai Nogami Kodai Sayama Yun Teng Hiroki Ueno Taishi Yonetsu Tetsuo Sasano Tsunekazu Kakuta |
| author_sort | Kazuki Matsuda |
| collection | DOAJ |
| description | ObjectivesThis study sought to assess the predictors of coronary computed tomography angiographic findings for non-infarct-related (non-IR) territory unrecognized myocardial infarction (UMI) in patients with a first episode of non-ST-elevation acute coronary syndrome (NSTE-ACS).BackgroundUMI detected by cardiac magnetic resonance imaging (CMR) is associated with adverse outcomes in patients with both acute coronary syndrome and chronic coronary syndrome. However, the association between the presence of UMI and coronary computed tomography angiographic (CCTA) findings remains unknown.MethodsWe investigated 158 patients with a first clinical episode of NSTE-ACS, who underwent pre-PCI 320-slice CCTA and uncomplicated urgent percutaneous coronary intervention (PCI) within 48 h of admission. In these patients, post-PCI CMR was performed within 30 days from urgent PCI and before non-IR lesion staged PCI. UMI was assessed using late gadolinium enhancement (LGE)-CMR by identifying regions of hyperenhancement with an ischemic distribution pattern in non-IR territories (non-IR UMI). CCTA analysis included qualitative and quantitative assessments of the culprit segment, Agatston score, mean peri-coronary fat attenuation index (FAI), epicardial fat volume (EFV) and epicardial fat attenuation (EFA).ResultsNon-IR UMI was detected in 30 vessel territories (9.7%, 30/308 vessels) of 28 patients (17.7%, 28/158 patients). The presence of low-attenuation plaque, spotty calcification, napkin ring sign, and positive remodeling was not significantly different between vessels with and without subtended non-IR UMI. Agatston score >30.0 (OR: 8.39, 95% confidence interval (CI): 2.17 to 32.45, p = 0.002), mean FAI >-64.3 (OR: 3.23, 95% CI: 1.34 to 7.81, p = 0.009), and stenosis severity (OR: 1.04, 95% CI: 1.02 to 1.06, p < 0.001) were independently associated with non-IR UMI. Neither EFV (p = 0.340) nor EFA (p = 0.700) was associated with non-IR UMI.ConclusionThe prevalence of non-IR UMI was 17.7 % in patients with first NSTE-ACS presentation. Agatston score, mean FAI, and coronary stenosis severity were independent CCTA predictors of the presence of non-IR UMI. The integrated CCTA assessment may help identify the presence of non-IR UMI before urgent PCI. |
| first_indexed | 2024-12-17T19:03:40Z |
| format | Article |
| id | doaj.art-58250dce2d16421dabe4d15002e1342a |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-17T19:03:40Z |
| publishDate | 2022-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-58250dce2d16421dabe4d15002e1342a2022-12-21T21:36:03ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-01-01810.3389/fcvm.2021.825523825523Coronary Computed Tomography Angiographic Predictors of Non-culprit Territory Unrecognized Myocardial Infarction Assessed by Cardiac Magnetic Resonance in Non-ST-elevation Acute Coronary SyndromeKazuki Matsuda0Masahiro Hoshino1Yoshihisa Kanaji2Tomoyo Sugiyama3Toru Misawa4Masahiro Hada5Tatsuhiro Nagamine6Kai Nogami7Kodai Sayama8Yun Teng9Hiroki Ueno10Taishi Yonetsu11Tetsuo Sasano12Tsunekazu Kakuta13Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JapanDivision of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JapanDivision of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JapanDivision of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JapanDivision of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JapanDivision of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JapanDivision of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JapanDivision of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JapanDivision of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JapanDivision of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JapanDivision of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JapanDepartment of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, JapanDivision of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JapanObjectivesThis study sought to assess the predictors of coronary computed tomography angiographic findings for non-infarct-related (non-IR) territory unrecognized myocardial infarction (UMI) in patients with a first episode of non-ST-elevation acute coronary syndrome (NSTE-ACS).BackgroundUMI detected by cardiac magnetic resonance imaging (CMR) is associated with adverse outcomes in patients with both acute coronary syndrome and chronic coronary syndrome. However, the association between the presence of UMI and coronary computed tomography angiographic (CCTA) findings remains unknown.MethodsWe investigated 158 patients with a first clinical episode of NSTE-ACS, who underwent pre-PCI 320-slice CCTA and uncomplicated urgent percutaneous coronary intervention (PCI) within 48 h of admission. In these patients, post-PCI CMR was performed within 30 days from urgent PCI and before non-IR lesion staged PCI. UMI was assessed using late gadolinium enhancement (LGE)-CMR by identifying regions of hyperenhancement with an ischemic distribution pattern in non-IR territories (non-IR UMI). CCTA analysis included qualitative and quantitative assessments of the culprit segment, Agatston score, mean peri-coronary fat attenuation index (FAI), epicardial fat volume (EFV) and epicardial fat attenuation (EFA).ResultsNon-IR UMI was detected in 30 vessel territories (9.7%, 30/308 vessels) of 28 patients (17.7%, 28/158 patients). The presence of low-attenuation plaque, spotty calcification, napkin ring sign, and positive remodeling was not significantly different between vessels with and without subtended non-IR UMI. Agatston score >30.0 (OR: 8.39, 95% confidence interval (CI): 2.17 to 32.45, p = 0.002), mean FAI >-64.3 (OR: 3.23, 95% CI: 1.34 to 7.81, p = 0.009), and stenosis severity (OR: 1.04, 95% CI: 1.02 to 1.06, p < 0.001) were independently associated with non-IR UMI. Neither EFV (p = 0.340) nor EFA (p = 0.700) was associated with non-IR UMI.ConclusionThe prevalence of non-IR UMI was 17.7 % in patients with first NSTE-ACS presentation. Agatston score, mean FAI, and coronary stenosis severity were independent CCTA predictors of the presence of non-IR UMI. The integrated CCTA assessment may help identify the presence of non-IR UMI before urgent PCI.https://www.frontiersin.org/articles/10.3389/fcvm.2021.825523/fullacute coronary syndromepercutaneous coronary interventionunrecognized myocardial infarctioncardiac magnetic resonance imagingcoronary computed tomography angiography |
| spellingShingle | Kazuki Matsuda Masahiro Hoshino Yoshihisa Kanaji Tomoyo Sugiyama Toru Misawa Masahiro Hada Tatsuhiro Nagamine Kai Nogami Kodai Sayama Yun Teng Hiroki Ueno Taishi Yonetsu Tetsuo Sasano Tsunekazu Kakuta Coronary Computed Tomography Angiographic Predictors of Non-culprit Territory Unrecognized Myocardial Infarction Assessed by Cardiac Magnetic Resonance in Non-ST-elevation Acute Coronary Syndrome Frontiers in Cardiovascular Medicine acute coronary syndrome percutaneous coronary intervention unrecognized myocardial infarction cardiac magnetic resonance imaging coronary computed tomography angiography |
| title | Coronary Computed Tomography Angiographic Predictors of Non-culprit Territory Unrecognized Myocardial Infarction Assessed by Cardiac Magnetic Resonance in Non-ST-elevation Acute Coronary Syndrome |
| title_full | Coronary Computed Tomography Angiographic Predictors of Non-culprit Territory Unrecognized Myocardial Infarction Assessed by Cardiac Magnetic Resonance in Non-ST-elevation Acute Coronary Syndrome |
| title_fullStr | Coronary Computed Tomography Angiographic Predictors of Non-culprit Territory Unrecognized Myocardial Infarction Assessed by Cardiac Magnetic Resonance in Non-ST-elevation Acute Coronary Syndrome |
| title_full_unstemmed | Coronary Computed Tomography Angiographic Predictors of Non-culprit Territory Unrecognized Myocardial Infarction Assessed by Cardiac Magnetic Resonance in Non-ST-elevation Acute Coronary Syndrome |
| title_short | Coronary Computed Tomography Angiographic Predictors of Non-culprit Territory Unrecognized Myocardial Infarction Assessed by Cardiac Magnetic Resonance in Non-ST-elevation Acute Coronary Syndrome |
| title_sort | coronary computed tomography angiographic predictors of non culprit territory unrecognized myocardial infarction assessed by cardiac magnetic resonance in non st elevation acute coronary syndrome |
| topic | acute coronary syndrome percutaneous coronary intervention unrecognized myocardial infarction cardiac magnetic resonance imaging coronary computed tomography angiography |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2021.825523/full |
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