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Noninvasive evaluation of coronary reperfusion by CT angiography in patients with STEMI

Makoto Yamashita1, Souki Lee, Shuichi Hamasaki

  • 1Department of Cardiology, Kagoshima City Hospital, Kagoshima, Japan.

JACC. Cardiovascular Imaging
|February 19, 2011
PubMed

Insights

64-slice multidetector computed tomography (MDCT) can accurately differentiate coronary reperfusion in ST-segment elevation myocardial infarction (STEMI) patients. This noninvasive imaging technique effectively distinguishes Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 from lower grades.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Multidetector computed tomography (MDCT) is increasingly utilized for noninvasive coronary artery imaging.
  • 64-slice MDCT specifically shows promise in evaluating coronary arteries in acute coronary artery disease.

Purpose of the Study:

  • To assess the capability of 64-slice MDCT in differentiating Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 from TIMI flow grade ≤ 2.
  • To evaluate coronary reperfusion after ST-segment elevation myocardial infarction (STEMI).

Main Methods:

  • 87 non-high-risk STEMI patients underwent 64-slice MDCT during the acute phase to visualize infarct-related arteries (IRA).
  • A computed tomography (CT) number ratio was calculated to differentiate TIMI flow grade 3 from 2.
  • MDCT findings were compared with invasive coronary angiography (ICA) results.

Main Results:

  • MDCT detected distal reperfusion in 28/29 patients with TIMI flow grade ≥ 2 and absent in 55/58 with TIMI flow grade ≤ 1.
  • The CT number ratio was significantly higher for TIMI flow grade 3 (0.64 ± 0.11) versus TIMI flow grade ≤ 2 (0.37 ± 0.12; p < 0.0001).
  • A CT number ratio cutoff of ≥ 0.54 achieved 92% sensitivity, 97% specificity, and 97% accuracy for diagnosing TIMI flow grade 3.

Conclusions:

  • 64-slice MDCT visualization of the IRA allows for noninvasive differentiation of coronary reperfusion.
  • This technique effectively distinguishes TIMI flow grade 3 from TIMI flow grade ≤ 2 in acute STEMI patients.
  • MDCT offers a valuable tool for assessing reperfusion status post-STEMI.
Abstract

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