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

Kathrine Ekström, Lars Nepper-Christensen, Kiril A. Ahtarovski, Kasper Kyhl, Christoffer Göransson, Litten Bertelsen, Adam A. Ghotbi, Henning Kelbæk, Steffen Helqvist, Dan E. Høfsten, Lars Køber, Mikkel M. Schoos, Niels Vejlstrup, Jacob Lønborg, Thomas Engstrøm

Research output: Contribution to journalArticlepeer-review

11 Citations (SciVal)

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 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)

Original languageEnglish
Pages (from-to)2168-2178
Number of pages11
JournalJACC: Cardiovascular Imaging
Volume12
Issue number11P1
DOIs
Publication statusPublished - 2019
Externally publishedYes

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

Keywords

  • cardiac magnetic resonance
  • late gadolinium enhancement
  • multiple myocardial infarctions
  • prognosis
  • ST-segment elevation myocardial infarction

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