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| The Impact of Coronary Artery Collaterals on Delayed Hyperenhancement in Cardiac MRI after Primary PCI in Patients with Acute Myocardial Infarction |
| Division of Cardiology, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea¹,Department of Radiology, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea ² |
| Se-Jung Yoon, Young-Guk Ko¹,Jung-Sun Kim¹,Jae-Youn Moon¹,Young-Jin Kim²,Sungha Park¹,Donghoon Choi¹,Yangsoo Jang¹,Namsik Chung¹ |
Background: Coronary collaterals, or ”natural bypasses” potentially offer an important alternative source of blood supply when the original vessel fails to provide sufficient blood such as in myocardial infarction. In myocardial infarction, there were many reports to show delayed hyperenhancement in cardiac magnetic resonance(CMR) correlates well with the infarct size and left ventricular function.Therefore, we investigated the impact of collateral flow on delayed hyperenhancement CMR in acute myocardial infarction (AMI).
Methods: A total of 40 patients (mean age 57.97±11.65, male : 72.5% ) who underwent primary percutaneous coronary intervention (PCI) were enrolled in the study; all of them had total occlusion of culprit coronary artery. Cardiac MRI was performed within 7 days after primary PCI and followed 3 months later. The thickness and area of contrast enhanced area of left ventricular wall was quantified by tracing.
Results: Thirty five patients (87.50%) showed collateral flow on coronary angiography and the range was diverse from grade 1 to 3 (Grade 1: 55.0 %, Grade 2 : 28.5 % : Grade 3 : 14.2 %). The thickness of delayed hyperenhancement area in with and without collateral flow group revealed significant differences in follow-up MRI (47.31±14.46% vs 61.33±15.17%, p-value=0.041) as well as mass(18.25±6.40% vs 32.05±20.74%, p-value=0.040). However, there was no statistically significant difference of hyperenhancement thickness and mass among the collateral flow subgroups (p-value=0.405, p-value=0.801). The thickness and mass of hyperenhanced LV revealed significant reduction in followed CMR of patients with collateral flow (59.41±13.00% vs 47.31±14.46% p=0.000) as well as mass(25.28±10.86% vs 18.25±6.40%, p-value=0.000).
Conclusions: The results of this study demonstrate that the presence of coronary collateral circulation in patients undergoing primary PCI has an impact on the infarcted myocardial thickness and mass as well as on the degree of reduction in infarct mass in CMR follow-up.
Key Words:Coronary Artery Collaterals, Myocardial Infarction, Delayed Hyperenhancement, MRI
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