%0 Journal Article
%T Cardiovascular magnetic resonance of scar and ischemia burden early after acute ST elevation and non-ST elevation myocardial infarction
%A Sven Plein
%A John F Younger
%A Patrick Sparrow
%A John P Ridgway
%A Stephen G Ball
%A John P Greenwood
%J Journal of Cardiovascular Magnetic Resonance
%D 2008
%I BioMed Central
%R 10.1186/1532-429x-10-47
%X 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¨C6 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.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.The acute coronary syndromes encompass ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina [1,2]. STEMI is typically the consequence of a complete occlusion of the culprit artery with an ultimately fibrin-rich thrombus, whilst NSTEMI is caused by a transient coronary occlusion or of micro-embolisation with components of a non-occlusive, often platelet-rich thrombus [2,3]. As a consequence of these pathophysiological differences, STEMI generally results in larger infarction than NSTEMI [4-6]. Q-waves on an electrocardiogram develop in approximately two thirds of STEMIs, largely depe
%U http://jcmr-online.com/content/10/1/47