Letter by Mewton and Croisille Regarding Article, “Identification of High-Risk Patients After ST-Segment–Elevation Myocardial Infarction: Comparison Between Angiographic and Magnetic Resonance Parameters”

HomeCirculation: Cardiovascular ImagingVol. 10, No. 9Letter by Mewton and Croisille Regarding Article, "Identification of High-Risk Patients After ST-Segment–Elevation Myocardial Infarction: Comparison Between Angiographic and Magnetic Resonance Parameters" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Mewton and Croisille Regarding Article, "Identification of High-Risk Patients After ST-Segment–Elevation Myocardial Infarction: Comparison Between Angiographic and Magnetic Resonance Parameters" Nathan Mewton, MD, PhD Pierre Croisille, MD, PhD Nathan MewtonNathan Mewton Cardiovascular Imaging Department, Cardiovascular Hospital Louis Pradel, Hospices Civils de Lyon, Lyon, FranceClinical Investigation Center, Cardiovascular Hospital Louis Pradel, Inserm 1407, Lyon, France Pierre CroisillePierre Croisille Radiology Department, University Hospital of Saint-Étienne, Saint-Étienne, FranceUniversity of Lyon, UJM-Saint-Étienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Étienne, France Originally published11 Sep 2017https://doi.org/10.1161/CIRCIMAGING.117.006915Circulation: Cardiovascular Imaging. 2017;10:e006915To the Editor:We read with interest in this month's issue of Circulation: Cardiovascular Imaging the article by Durante et al1 showing a significant difference between contrast-enhanced cardiac magnetic resonance and coronary angiography for the definition of microvascular obstruction. We had found similar results on a smaller cohort yet with an even greater difference between angiography contrast-enhanced cardiac magnetic resonance.2In this work, the authors find an unusually high proportion of ST-segment–elevation myocardial infarction patients with angiographic no reflow (35% versus only 26% in the TAPAS trial [Thrombus Aspiration During Percutaneous Coronary Intervention in Acute Myocardial Infarction Study] control group3), and the specific data on how no reflow was defined between thrombolysis in myocardial infarction flow grade and myocardial blush grade are not shown. What was the exact correlation between final thrombolysis in myocardial infarction flow and contrast-enhanced cardiac magnetic resonance microvascular obstruction?Also, the very large difference in proportion between angiographic no reflow and contrast-enhanced cardiac magnetic resonance microvascular obstruction is mainly because of pathophysiology. Coronary angiography only gives an index of very early microvascular damage. The damage to myocardial microcirculation has been shown to be a very dynamic phenomenon developing and amplifying at least in the first 48 hours after reperfusion.4 It should be therefore stated once and for all that coronary angiography is not a good diagnostic tool for precise microvascular obstruction damage.Nathan Mewton, MD, PhDCardiovascular Imaging DepartmentCardiovascular Hospital Louis Pradel, Hospices Civils de Lyon,Lyon, FranceClinical Investigation CenterCardiovascular Hospital Louis Pradel, Inserm 1407Lyon, FrancePierre Croisille, MD, PhDRadiology DepartmentUniversity Hospital of Saint-ÉtienneSaint-Étienne, FranceUniversity of Lyon, UJM-Saint-Étienne, INSA, CNRS UMR 5520,INSERM U1206, CREATIS, F-42023Saint-Étienne, FranceDisclosuresNone.References1. Durante A, Laricchia A, Benedetti G, Esposito A, Margonato A, Rimoldi O, De Cobelli F, Colombo A, Camici PG. Identification of high-risk patients after ST-segment–elevation myocardial infarction: comparison between angiographic and magnetic resonance parameters.Circ Cardiovasc Imaging. 2017; 10:e005841. doi: 10.1161/CIRCIMAGING.116.005841.LinkGoogle Scholar2. Vicente J, Mewton N, Croisille P, Staat P, Bonnefoy-Cudraz E, Ovize M, Revel D. Comparison of the angiographic myocardial blush grade with delayed-enhanced cardiac magnetic resonance for the assessment of microvascular obstruction in acute myocardial infarctions.Catheter Cardiovasc Interv. 2009; 74:1000–1007. doi: 10.1002/ccd.22157.CrossrefMedlineGoogle Scholar3. Svilaas T, Vlaar PJ, van der Horst IC, Diercks GF, de Smet BJ, van den Heuvel AF, Anthonio RL, Jessurun GA, Tan ES, Suurmeijer AJ, Zijlstra F. Thrombus aspiration during primary percutaneous coronary intervention.N Engl J Med. 2008; 358:557–567. doi: 10.1056/NEJMoa0706416.CrossrefMedlineGoogle Scholar4. Rochitte CE, Lima JA, Bluemke DA, Reeder SB, McVeigh ER, Furuta T, Becker LC, Melin JA. Magnitude and time course of microvascular obstruction and tissue injury after acute myocardial infarction.Circulation. 1998; 98:1006–1014.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails September 2017Vol 10, Issue 9 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.117.006915PMID: 28893796 Originally publishedSeptember 11, 2017 PDF download Advertisement SubjectsMagnetic Resonance Imaging (MRI)Myocardial InfarctionPrognosis