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100 Prognostic significance of post-procedural irreversible myocardial injury detected by cardiovascular magnetic resonance imaging

Introduction

Controversy remains over the prognostic significance of revascularization procedure related myocardial injury. Delayed enhancement cardiovascular magnetic resonance imaging (DE-CMR) has been shown to reliably identify areas of irreversible myocardial injury.

Purpose

In the present study, we evaluated the prognostic significance of procedure related myocardial injury in a consecutive series of patients undergoing high risk PCI or CABG.

Methods and Results

152 patients underwent DE-CMR for assessment of new irreversible injury pre and 1 to 6 days post elective PCI or CABG. Primary endpoint was defined as total mortality, non-fatal myocardial infarction (MI), ventricular arrhythmia terminated by ICD (VA), and unstable angina or heart failure requiring hospitalization. Secondary endpoint was the composite of total mortality, non-fatal MI and VA. During a median follow-up of 2.9 years, 27 patients (18%) reached the primary endpoint and 12 patients (8%) the secondary endpoint. 49 patients (32%) had evidence of new myocardial hyperenhancement (HE) with a median mass of 5.0 g (IQR 2.7–9.8). In a univariate analysis, age, LV ejection fraction post intervention, and presence of new HE were predictive of the primary outcome. Elevated troponin (at 24 h) showed a trend towards poorer outcome. In a multivariate Cox regression analysis only age and presence of new HE (Hazard ratio 2.7, 95% CI 1.03, 5.79) remained independently correlated with occurrence of the primary endpoint. New myocardial HE was the single independent predictor of the composite secondary endpoint (HR 4.2, 95% CI 1.07, 16.12).

Conclusion

Even small amounts of procedure-related myocardial injury are associated with poorer medium term clinical outcomes. CMR identified myocardial injury may be a stronger prognostic marker than cardiac troponin in the setting of coronary revascularization.

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Correspondence to Joseph B Selvanayagam.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Selvanayagam, J.B., Rahimi, K., Banning, A. et al. 100 Prognostic significance of post-procedural irreversible myocardial injury detected by cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 10, A1 (2008). https://doi.org/10.1186/1532-429X-10-S1-A1

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Keywords

  • Secondary Endpoint
  • Ventricular Arrhythmia
  • Myocardial Injury
  • Elevated Troponin
  • Cardiovascular Magnetic Resonance Imaging