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

Kathrine Ekström1, Lars Nepper-Christensen1, Kiril A Ahtarovski1

  • 1Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark.

JACC. Cardiovascular Imaging
|April 22, 2019
PubMed

Insights

Multiple myocardial scars were found in 8.4% of ST-segment elevation myocardial infarction (STEMI) patients. These scars independently increase the risk of long-term mortality and heart failure hospitalization, aiding risk stratification.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Clinical Research

Background:

  • Multiple myocardial scars in ST-segment elevation myocardial infarction (STEMI) patients can arise from various causes, including multiple culprit lesions or procedure-related damage.
  • The incidence, long-term prognosis, and specific causes of multiple myocardial scars in STEMI patients are not well-established.

Purpose of the Study:

  • To investigate the incidence of multiple myocardial scars in STEMI patients using cardiac magnetic resonance (CMR).
  • To determine the long-term prognostic importance of multiple myocardial scars in STEMI patients.

Main Methods:

  • Cardiac magnetic resonance (CMR) imaging was performed on 704 STEMI patients post-primary percutaneous coronary intervention (PCI) and at 3-month follow-up.
  • Myocardial scars were identified using late gadolinium enhancement (LGE), and T2-weighted imaging differentiated acute from chronic infarctions.
  • Multiple scars were defined as scars in different coronary territories, with outcomes (mortality, heart failure hospitalization) tracked for 39 months.

Main Results:

  • At 3 months, 59 patients (8.4%) exhibited multiple myocardial scars.
  • The most common cause was a pre-existing chronic scar in non-culprit myocardium; new scars developed in 1.4% of patients.
  • Multiple scars were independently associated with a 2.7-fold increased risk of all-cause mortality and heart failure hospitalization (HR: 2.7; 95% CI: 1.1–6.8; P=0.037).

Conclusions:

  • Multiple myocardial scars are present in 8.4% of STEMI patients and are linked to significantly increased long-term morbidity and mortality.
  • Identifying multiple myocardial scars via CMR is a valuable tool for risk stratification in post-STEMI patients.
Abstract

Keywords:
ST-segment elevation myocardial infarctioncardiac magnetic resonancelate gadolinium enhancementmultiple myocardial infarctionsprognosis

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