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Impact of Multiple Myocardial Scars Detected by CMR in Patients Following STEMI

Ekström, Kathrine ; Nepper-Christensen, Lars ; Ahtarovski, Kiril A. ; Kyhl, Kasper ; Göransson, Christoffer ; Bertelsen, Litten ; Ghotbi, Adam A. ; Kelbæk, Henning ; Helqvist, Steffen and Høfsten, Dan E. , et al. (2019) In JACC: Cardiovascular Imaging 12(11P1). p.2168-2178
Abstract

Objectives: This study investigated the incidence and long-term prognostic importance of multiple myocardial scars in cardiac magnetic resonance (CMR) in a large contemporary cohort of patients with ST-segment elevation myocardial infarction (STEMI). Background: Patients presenting with STEMI may have multiple infarctions/scars caused by multiple culprit lesions, previous myocardial infarction (MI) or procedure-related MI due to nonculprit interventions. However, the incidence, long-term prognosis, and distribution of causes of multiple myocardial scars remain unknown. Methods: CMR was performed in 704 patients with STEMI 1 day after primary percutaneous coronary intervention (PCI) and again 3 months later. Myocardial scars were... (More)

Objectives: This study investigated the incidence and long-term prognostic importance of multiple myocardial scars in cardiac magnetic resonance (CMR) in a large contemporary cohort of patients with ST-segment elevation myocardial infarction (STEMI). Background: Patients presenting with STEMI may have multiple infarctions/scars caused by multiple culprit lesions, previous myocardial infarction (MI) or procedure-related MI due to nonculprit interventions. However, the incidence, long-term prognosis, and distribution of causes of multiple myocardial scars remain unknown. Methods: CMR was performed in 704 patients with STEMI 1 day after primary percutaneous coronary intervention (PCI) and again 3 months later. Myocardial scars were assessed by late gadolinium enhancement (LGE). T2-weighted technique was used to differentiate acute from chronic infarctions. The presence of multiple scars was defined as scars located in different coronary territories. The combined endpoints of all-cause mortality and hospitalization for heart failure were assessed at 39 months (interquartile range [IQR]: 31 to 48 months). Results: At 3 months, 59 patients (8.4%) had multiple scars. Of these, multiple culprits in STEMI were detected in 7 patients (1%), and development of a second nonculprit scar at follow-up occurred in 10 patients (1.4%). The most frequent cause of multiple scars was a chronic scar in the nonculprit myocardium. The presence of multiple scars was independently associated with an increased risk of all-cause mortality and hospitalization for heart failure (hazard ratio: 2.7; 95% confidence interval: 1.1 to 6.8; p = 0.037). Conclusions: Multiple scars were present in 8.4% of patients with STEMI and were independently associated with an increased risk of long-term morbidity and mortality. The presence of multiple myocardial scars on CMR may serve as a useful tool in risk stratification of patients following STEMI. (DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction [DANAMI-3]; NCT01435408) (Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization [PRIMULTI]; NCT01960933)

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
cardiac magnetic resonance, late gadolinium enhancement, multiple myocardial infarctions, prognosis, ST-segment elevation myocardial infarction
in
JACC: Cardiovascular Imaging
volume
12
issue
11P1
pages
11 pages
publisher
Elsevier
external identifiers
  • pmid:31005537
  • scopus:85073995450
ISSN
1936-878X
DOI
10.1016/j.jcmg.2019.01.032
language
English
LU publication?
no
id
56b62f2a-ce37-46d0-a559-48ccbafdf9fd
date added to LUP
2019-11-05 11:08:25
date last changed
2022-08-03 18:43:45
@article{56b62f2a-ce37-46d0-a559-48ccbafdf9fd,
  abstract     = {{<p>Objectives: This study investigated the incidence and long-term prognostic importance of multiple myocardial scars in cardiac magnetic resonance (CMR) in a large contemporary cohort of patients with ST-segment elevation myocardial infarction (STEMI). Background: Patients presenting with STEMI may have multiple infarctions/scars caused by multiple culprit lesions, previous myocardial infarction (MI) or procedure-related MI due to nonculprit interventions. However, the incidence, long-term prognosis, and distribution of causes of multiple myocardial scars remain unknown. Methods: CMR was performed in 704 patients with STEMI 1 day after primary percutaneous coronary intervention (PCI) and again 3 months later. Myocardial scars were assessed by late gadolinium enhancement (LGE). T2-weighted technique was used to differentiate acute from chronic infarctions. The presence of multiple scars was defined as scars located in different coronary territories. The combined endpoints of all-cause mortality and hospitalization for heart failure were assessed at 39 months (interquartile range [IQR]: 31 to 48 months). Results: At 3 months, 59 patients (8.4%) had multiple scars. Of these, multiple culprits in STEMI were detected in 7 patients (1%), and development of a second nonculprit scar at follow-up occurred in 10 patients (1.4%). The most frequent cause of multiple scars was a chronic scar in the nonculprit myocardium. The presence of multiple scars was independently associated with an increased risk of all-cause mortality and hospitalization for heart failure (hazard ratio: 2.7; 95% confidence interval: 1.1 to 6.8; p = 0.037). Conclusions: Multiple scars were present in 8.4% of patients with STEMI and were independently associated with an increased risk of long-term morbidity and mortality. The presence of multiple myocardial scars on CMR may serve as a useful tool in risk stratification of patients following STEMI. (DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction [DANAMI-3]; NCT01435408) (Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization [PRIMULTI]; NCT01960933)</p>}},
  author       = {{Ekström, Kathrine and Nepper-Christensen, Lars and Ahtarovski, Kiril A. and Kyhl, Kasper and Göransson, Christoffer and Bertelsen, Litten and Ghotbi, Adam A. and Kelbæk, Henning and Helqvist, Steffen and Høfsten, Dan E. and Køber, Lars and Schoos, Mikkel M. and Vejlstrup, Niels and Lønborg, Jacob and Engstrøm, Thomas}},
  issn         = {{1936-878X}},
  keywords     = {{cardiac magnetic resonance; late gadolinium enhancement; multiple myocardial infarctions; prognosis; ST-segment elevation myocardial infarction}},
  language     = {{eng}},
  number       = {{11P1}},
  pages        = {{2168--2178}},
  publisher    = {{Elsevier}},
  series       = {{JACC: Cardiovascular Imaging}},
  title        = {{Impact of Multiple Myocardial Scars Detected by CMR in Patients Following STEMI}},
  url          = {{http://dx.doi.org/10.1016/j.jcmg.2019.01.032}},
  doi          = {{10.1016/j.jcmg.2019.01.032}},
  volume       = {{12}},
  year         = {{2019}},
}