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

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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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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan

    Masahiro Hoshino, Tomoyo Sugiyama, Yoshihisa Kanaji, Masahiro Hada, Tatsuhiro Nagamine, Kai Nogami, Hiroki Ueno, Kodai Sayama, Kazuki Matsuda & Tsunekazu Kakuta

  2. Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan

    Taishi Yonetsu

  3. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Tetsuo Sasano

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  1. Masahiro Hoshino
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Contributions

M.Hoshino, T.S., Y.K., M.Hada, T.N., K.N., Y.T., H.U., K.S., K.M., T.Y., and T.Sasano. analyzed and interpreted the patients’ data. M.Hoshino, T.S., T.M., M.Hada, T.N., K.N., Y.T., H.U. K.S., and K.M. made effort to enroll the patients. M.Hoshino and T.K. were major contributors in writing the manuscript. All authors read and approved the final manuscript.

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Correspondence to Tsunekazu Kakuta.

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Hoshino, M., Sugiyama, T., Kanaji, Y. et al. Multimodality coronary imaging to predict non-culprit territory unrecognized myocardial infarction in Non-ST-Elevation acute coronary syndrome. Int J Cardiovasc Imaging 39, 2051–2061 (2023). https://doi.org/10.1007/s10554-023-02903-0

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