MDCT just as accurate as MRI in assessing myocardial infarction in emergency setting

August 05, 2008

Multidetector CT (MDCT) is just as accurate as MRI in assessing myocardial infarct size--an important predictor of clinical outcome-- in an emergency setting according to a recent study conducted by researchers in collaboration between the VA Medical Center in San Francisco, CA and the University Claude Bernard in Lyon, France.

"The size of the infarct is one of the most important predictors of long-term left ventricular function in patients with an acute myocardial infarction," said Loic Boussel, MD, lead author of the study. "Imaging of myocardial infarct size is difficult in the emergency setting as the current 'gold standard' methods of delayed enhanced MRI and nuclear medicine techniques are difficult to perform in unstable patients. CT is very easy and quick to perform even at the acute phase so we wanted to find out if it can do the same job as MRI and potentially provide further information," he said.

The study included 19 patients with acute myocardial infarction who underwent delayed enhanced MDCT immediately after coronary angioplasty and underwent delayed enhanced MRI within eight days of angioplasty. The study showed that there was agreement between MRI and MDCT. MDCT had a sensitivity and specificity of 87.6% and 97.7% for the classification of the volume of the myocardial infarct when compared to MRI.

Dr. Boussel noted that MDCT did not require an additional contrast injection and is very practical in an emergency setting.

American Roentgen Ray Society

---

---

	Myocardial Infarction: An Incredibly Easy! Miniguide by Springhouse (Author) This concise, portable reference has virtually everything nurses need to master care for this common life-threatening condition that affects more than a million and a half people each year. Contents include understanding MI, preventing MI, assessing patients with MI, treating patients with MI, MI complications, and teaching patients with MI.
	ARRHYTHMIAS AFTER ACUTE MYOCARDIAL INFARCTION: Evaluation and management of rhythm and conduction abnormalities (Postgraduate Medicine) by JTE Multimedia Patients with myocardial infarction can experience a wide range of arrhythmias and conduction abnormalities, from transient and relatively innocuous sinus bradycardia to life-threatening ventricular fibrillation. This nuts-and-bolts article covers all the possibilities, emphasizing the clinical significance of the various arrhythmias and their evaluation and treatment. Also included are indications for temporary and permanent pacemaker placement based on the revised ACC/AHA guidelines. Original Publication Date: November 1997
	The 12-Lead ECG: In Acute Myocardial Infarction by Tim Phalen (Author) This text provides information on 12-lead ECG interpretation and appropriate thrombolytic therapy. Topics are presented logically, step-by-step, and fully illustrated. Essential for anyone using Advanced Cardiac Life Support in a pre-hospital setting.
	Continuum of Care in the Treatment of ST-Segment Elevation Myocardial Infarction (STEMI): Importance of Platelet and Coagulation Inhibition (Postgraduate Medicine) by JTE Multimedia Abstract: ST-segment elevation myocardial infarction (STEMI) is a serious manifestation of atherothrombosis. Platelets play an important role in the pathogenesis of atherothrombosis, and the use of antiplatelet agents is associated with substantial improvements in clinical outcome. Current guidelines for the management of patients with STEMI stress the importance of using antiplatelet agents as an integral part of acute and long-term therapy. However, these and other recommended therapies are frequently underutilized. In-hospital quality improvement initiatives have been shown to substantially improve adherence to guideline-recommended therapies at the time of discharge. This review discusses the role of platelets in atherothrombosis and describes the medical management of patients with...
	MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION: Synopsis of ACC and AHA practice guidelines (Postgraduate Medicine) by JTE Multimedia The average time that elapses from a patient's first awareness of heart attack symptoms to start-up of specific reperfusion therapy is currently 4 hours. The National Heart Attack Alert Program wants to see this time reduced to 2 hours. Such dispatch would surely benefit patients, because when it comes to thrombolytic therapy, the sooner the better. Dr Ryan summarizes the new recommendations for handling patients with acute myocardial infarction rapidly and efficiently, from the 911 call and transport to the emergency department, through the important first 24 hours of hospitalization, to hospital discharge and long-term management. Original Publication Date: November 1997
	Clinical Impact of Enhanced Inhibition of P2Y12-Mediated Platelet Aggregation in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous ... Coronary Intervention (Hospital Practice) by JTE Multimedia The combination of aspirin and clopidogrel at a loading dose of 300 mg followed by a maintenance dose of 75 mg daily is a well-established antiplatelet therapy for the secondary prevention of thrombotic complications in the settings of acute coronary syndrome and/or percutaneous coronary intervention (PCI). Despite the demonstrated clinical benefits associated with this antiplatelet therapy, there is accumulating evidence that a consistent proportion of patients persist in having high levels of platelet aggregation following standard clopidogrel dose. Importantly, the high platelet reactivity after clopidogrel treatment has been associated with higher risk for cardiovascular ischemic events, including stent thrombosis. This has warranted the need for alternative oral antiplatelet regimens...
	A Review and Meta-Analysis of Studies on the Effect and Timing of ?-Blocker Administration in Patients with ST-Segment Elevation Myocardial Infarction (Hospital Practice) by JTE Multimedia The utility of β-blockers during an evolving ST-segment elevation myocardial infarction (STEMI) has substantial theoretic physiological backing. This coupled with early successes using β-blockers in STEMI promulgated multiple guidelines expanding the use of this class of medication to all patients with acute coronary syndromes. However, recent studies have questioned the utility of β-blockers in the emergency department in these patients. The purpose of this article is to review the evidence behind the use of β-blockers in the emergency department for STEMI patients.
	PHARMACOLOGIC THERAPY FOR ACUTE MYOCARDIAL INFARCTION: Which agent, how much, how soon, how long? (Postgraduate Medicine) by JTE Multimedia Is there any good reason to give intravenous nitroglycerin during evolving acute myocardial infarction? How about a beta blocker? Should an ACE inhibitor be started routinely within the first 24 hours of infarction? When is aspirin useful for suspected acute myocardial infarction? Is it safe in patients with contraindications to thrombolytic therapy? In this article, Dr Rapaport answers these and many more questions by summarizing findings of important studies and describing conclusions he has come to on the basis of his own clinical experience. Original Publication Date: November 1997
	THROMBOLYTIC THERAPY VERSUS PRIMARY ANGIOPLASTY: Which offers the best outcome after myocardial infarction? (Postgraduate Medicine) by JTE Multimedia The best technique for reestablishing blood flow after myocardial infarction has been the subject of heated debate for more than a decade. And the answer is still elusive. Which option is the safest? Which salvages the most heart tissue? Dr Faxon explains the pros and cons of both thrombolysis and angioplasty and discusses the "90 rule," which helps determine the optimal reperfusion strategy for each individual patient. Original Publication Date: November 1997
	ROLE OF CARDIAC MARKERS IN EVALUATION OF SUSPECTED MYOCARDIAL INFARCTION: Selecting the most clinically useful indicators (Postgraduate Medicine) by JTE Multimedia In the workup of a patient with chest pain, knowing which cardiac marker or markers to measure is not always easy. Many factors affect the choice of the most clinically effective test: elapsed time after onset of pain, possible presence of skeletal muscle injury, potential delays in receiving test results, to name a few. In this review article, Dr Mercer compares the current cardiac markers, rates them according to the 10 characteristics of the ideal marker, and offers guidelines for selecting the appropriate marker in various clinical settings. Original Publication Date: November 1997