Abstract

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.

Highlights

  • A large proportion of acute myocardial infarction (MI) is asymptomatic or atypically presented without clinical recognition [1,2,3]

  • The final analysis was performed on 158 patients with complete pre-percutaneous coronary intervention (PCI) coronary computed tomography angiography (CCTA) and post-PCI delayed enhancement (DE)-cardiac magnetic resonance imaging (CMR) data

  • This study investigated the prevalence of non-IR Unrecognized myocardial infarction (UMI) and its CCTA-derived predictors in patients with a first clinical episode of NSTE-ACS

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Summary

Introduction

A large proportion of acute myocardial infarction (MI) is asymptomatic or atypically presented without clinical recognition [1,2,3]. Unrecognized myocardial infarction (UMI) has been reported to constitute up to more than 50% of all MI in the general population and in the cohort older than 60 years or in patients with chronic coronary syndrome, depending on the cardiovascular risk and modalities to detect UMI [4, 5]. The presence of unrecognized myocardial scar detected by late gadolinium enhancement (LGE) in patients presenting with the first acute AMI has been reported to be associated with worse outcomes [6, 7]. In this study, we sought to assess the prevalence of non-infarct-related territory UMI (non-IR UMI) in patients presenting with a first episode of NSTE-ACS without a history of MI, PCI, or coronary artery bypass graft (CABG). The association between the presence of UMI and coronary computed tomography angiographic (CCTA) findings remains unknown

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