Key result
Prior to revascularization, scar mass was highest in Q-STEMI (24.1%) and lowest in NSTEMI (3.8%), whereas ischemia mass was highest in NSTEMI (19.9%) and lowest in Q-STEMI (6.9%).
Why the study?
How do scar and ischemia mass assessed by CMR differ between patients with NSTEMI, Q-STEMI, and Non-Q STEMI early after presentation?
Cohort (n=75)
No
How do scar and ischemia mass assessed by CMR differ between patients with NSTEMI, Q-STEMI, and Non-Q STEMI early after presentation?
CMR reveals that while the combined mass of scar and ischemia is similar across MI types, the ratio of scar to ischemia is highest in Q-STEMI and lowest in NSTEMI, reflecting their diverse pathophysiology.
Answers are grounded in this paper and cite their sources.
Scar-ischemia ratios differ by MI type on CMR; leaves open whether these phenotypes guide risk stratification or revascularization.
BACKGROUND: The acute coronary syndrome diagnosis includes different classifications of myocardial infarction, which have been shown to differ in their pathology, as well as their early and late prognosis. These differences may relate to the underlying extent of infarction and/or residual myocardial ischemia. The study aim was to compare scar and ischemia mass between acute non-ST elevation myocardial infarction (NSTEMI), ST-elevation MI with Q-wave formation (Q-STEMI) and ST-elevation MI without Q-wave formation (Non-Q STEMI) in-vivo, using cardiovascular magnetic resonance (CMR). METHODS AND RESULTS: This was a prospective cohort study of twenty five consecutive patients with NSTEMI, 25 patients with thrombolysed Q-STEMI and 25 patients with thrombolysed Non-Q STEMI. Myocardial function (cine imaging), ischemia (adenosine stress first pass myocardial perfusion) and scar (late gadolinium enhancement) were assessed by CMR 2-6 days after presentation and before any invasive revascularisation procedure. All subjects gave written informed consent and ethical committee approval was obtained. Scar mass was highest in Q-STEMI, followed by Non-Q STEMI and NSTEMI (24.1%, 15.2% and 3.8% of LV mass, respectively; p < 0.0001). Ischemia mass showed the reverse trend and was lowest in Q-STEMI, followed by Non-Q STEMI and NSTEMI (6.9%, 14.7% and 19.9% of LV mass, respectively; p = 0.012). The combined mass of scar and ischemia was similar between the three groups (p = 0.17). The ratio of scar to ischemia was 3.5, 1.0 and 0.2 for Q-STEMI, Non-Q STEMI and NSTEMI, respectively. CONCLUSION: Prior to revascularisation, the ratio of scar to ischemia differs between NSTEMI, Non-Q STEMI and Q-STEMI, whilst the combined scar and ischemia mass is similar between these three types of MI. These results provide in-vivo confirmation of the diverse pathophysiology of different types of acute myocardial infarction and may explain their divergent early and late prognosis.
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Plein et al. (2008) conducted a cohort in Acute myocardial infarction (NSTEMI, Non-Q STEMI, Q-STEMI) (n=75). Myocardial infarction type (NSTEMI, Non-Q STEMI, Q-STEMI) vs. Comparison between MI types was evaluated on Scar mass (% of LV mass) (p=<0.0001). Prior to revascularization, scar mass was highest in Q-STEMI (24.1%) and lowest in NSTEMI (3.8%), whereas ischemia mass was highest in NSTEMI (19.9%) and lowest in Q-STEMI (6.9%).
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