PMID- 31005537 OWN - NLM STAT- MEDLINE DCOM- 20200819 LR - 20200819 IS - 1876-7591 (Electronic) IS - 1876-7591 (Linking) VI - 12 IP - 11 Pt 1 DP - 2019 Nov TI - Impact of Multiple Myocardial Scars Detected by CMR in Patients Following STEMI. PG - 2168-2178 LID - S1936-878X(19)30241-4 [pii] LID - 10.1016/j.jcmg.2019.01.032 [doi] AB - OBJECTIVES: This study investigated the incidence and long-term prognostic importance of multiple myocardial scars in cardiac magnetic resonance (CMR) in a large contemporary cohort of patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Patients presenting with STEMI may have multiple infarctions/scars caused by multiple culprit lesions, previous myocardial infarction (MI) or procedure-related MI due to nonculprit interventions. However, the incidence, long-term prognosis, and distribution of causes of multiple myocardial scars remain unknown. METHODS: CMR was performed in 704 patients with STEMI 1 day after primary percutaneous coronary intervention (PCI) and again 3 months later. Myocardial scars were assessed by late gadolinium enhancement (LGE). T2-weighted technique was used to differentiate acute from chronic infarctions. The presence of multiple scars was defined as scars located in different coronary territories. The combined endpoints of all-cause mortality and hospitalization for heart failure were assessed at 39 months (interquartile range [IQR]: 31 to 48 months). RESULTS: At 3 months, 59 patients (8.4%) had multiple scars. Of these, multiple culprits in STEMI were detected in 7 patients (1%), and development of a second nonculprit scar at follow-up occurred in 10 patients (1.4%). The most frequent cause of multiple scars was a chronic scar in the nonculprit myocardium. The presence of multiple scars was independently associated with an increased risk of all-cause mortality and hospitalization for heart failure (hazard ratio: 2.7; 95% confidence interval: 1.1 to 6.8; p = 0.037). CONCLUSIONS: Multiple scars were present in 8.4% of patients with STEMI and were independently associated with an increased risk of long-term morbidity and mortality. The presence of multiple myocardial scars on CMR may serve as a useful tool in risk stratification of patients following STEMI. (DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction [DANAMI-3]; NCT01435408) (Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization [PRIMULTI]; NCT01960933). CI - Copyright (c) 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Ekstrom, Kathrine AU - Ekstrom K AD - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark. Electronic address: kathrine.ekstroem@gmail.com. FAU - Nepper-Christensen, Lars AU - Nepper-Christensen L AD - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Ahtarovski, Kiril A AU - Ahtarovski KA AD - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Kyhl, Kasper AU - Kyhl K AD - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Goransson, Christoffer AU - Goransson C AD - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Bertelsen, Litten AU - Bertelsen L AD - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Ghotbi, Adam A AU - Ghotbi AA AD - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Kelbaek, Henning AU - Kelbaek H AD - Department of Cardiology, Zealand University Hospital, Roskilde, Denmark. FAU - Helqvist, Steffen AU - Helqvist S AD - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Hofsten, Dan E AU - Hofsten DE AD - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Kober, Lars AU - Kober L AD - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Schoos, Mikkel M AU - Schoos MM AD - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Vejlstrup, Niels AU - Vejlstrup N AD - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Lonborg, Jacob AU - Lonborg J AD - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Engstrom, Thomas AU - Engstrom T AD - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Cardiology, Lund University Hospital, Lund, Sweden. LA - eng SI - ClinicalTrials.gov/NCT01435408 SI - ClinicalTrials.gov/NCT01960933 PT - Clinical Trial PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20190417 PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 RN - 0 (Contrast Media) SB - IM CIN - JACC Cardiovasc Imaging. 2019 Nov;12(11 Pt 1):2179-2181. PMID: 31005525 MH - Aged MH - Cicatrix/*diagnostic imaging/mortality/pathology MH - Contrast Media/administration & dosage MH - Denmark/epidemiology MH - Female MH - Heart Failure/mortality/therapy MH - Hospitalization MH - Humans MH - Incidence MH - *Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Myocardium/*pathology MH - Percutaneous Coronary Intervention MH - Predictive Value of Tests MH - Risk Assessment MH - Risk Factors MH - ST Elevation Myocardial Infarction/*diagnostic imaging/mortality/pathology/therapy MH - Time Factors MH - Treatment Outcome OTO - NOTNLM OT - ST-segment elevation myocardial infarction OT - cardiac magnetic resonance OT - late gadolinium enhancement OT - multiple myocardial infarctions OT - prognosis EDAT- 2019/04/22 06:00 MHDA- 2020/08/20 06:00 CRDT- 2019/04/22 06:00 PHST- 2018/09/13 00:00 [received] PHST- 2019/01/16 00:00 [revised] PHST- 2019/01/30 00:00 [accepted] PHST- 2019/04/22 06:00 [pubmed] PHST- 2020/08/20 06:00 [medline] PHST- 2019/04/22 06:00 [entrez] AID - S1936-878X(19)30241-4 [pii] AID - 10.1016/j.jcmg.2019.01.032 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2019 Nov;12(11 Pt 1):2168-2178. doi: 10.1016/j.jcmg.2019.01.032. Epub 2019 Apr 17.