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Original Research

Acute Myocardial Infarction: Safety of Cardiac MR Imaging after Percutaneous Revascularization with Stents

Published Online:Sep 1 2006https://doi.org/10.1148/radiol.2403050740

Abstract

Purpose: To retrospectively determine the safety of cardiac magnetic resonance (MR) imaging performed early (<14 days) after coronary stent implantation in patients with acute myocardial infarction (AMI).

Materials and Methods: This HIPPA-compliant study was approved by the institutional review board; the informed consent requirement was waived. Consecutive patients with AMI who underwent cardiac MR imaging (study group) shortly after stent implantation (median, 3 days) were compared with control subjects who did not undergo MR imaging and were matched for clinical factors and angiographic extent of coronary disease. A 1.5-T MR imager was used to evaluate cine function, perfusion, and viability. Rates of death, nonfatal myocardial infarction, or revascularization 30 days and 6 months after stent implantation were compared with χ2 analysis.

Results: The study group consisted of 66 patients (median age, 56 years; 17 women) with 97 stents, 38 (39%) of which were drug eluting. The control group included 124 patients (median age, 58 years; 23% women) with 197 stents, 21 (10.7%) of which were drug eluting. There was no significant (P = .13) difference in the combined end point of death, nonfatal myocardial infarction, or revascularization between the study (2.0% [95% confidence interval: 0.0%, 4.5%]) and control (6.5% [95% confidence interval: 1.6%, 11.3%]) groups at 30-day follow-up. The event-free survival rate at 6-month follow-up was 91% in the study group and 83.7% in the control group (P = .18). Considering the end points separately, there was no difference in the event rate at 30-day or 6-month follow-up between groups. No adverse cardiovascular events occurred in patients with drug-eluting stents who underwent MR imaging.

Conclusion: Cardiac MR imaging performed shortly after AMI and percutaneous revascularization with bare metal or drug-eluting stents appears safe. The risk of adverse cardiovascular events is low and similar to that in patients who do not undergo MR imaging.

© RSNA, 2006

References

  • 1 Farb A, Sangiorgi G, Carter AJ, et al. Pathology of acute and chronic coronary stenting in humans. Circulation 1999; 99: 44–52.
    Medline Google Scholar
  • 2 Van Belle E, Tio FO, Couffinhal T, Maillard L, Passeri J, Isner JM. Stent endothelialization: time course, impact of local catheter delivery, feasibility of recombinant protein administration, and response to cytokine expedition. Circulation 1997; 95: 438–448.
    Medline Google Scholar
  • 3 Schneider DB, Dichek DA. Intravascular stent endothelialization: a goal worth pursuing? Circulation 1997; 95: 308–310.
    Medline Google Scholar
  • 4 Strohm O, Kivelitz D, Gross W, et al. Safety of implantable coronary stents during 1H-magnetic resonance imaging at 1.0 and 1.5 T. J Cardiovasc Magn Reson 1999; 1: 239–245.
    Medline Google Scholar
  • 5 Hug J, Nagel E, Bornstedt A, Schnackenburg B, Oswald H, Fleck E. Coronary arterial stents: safety and artifacts during MR imaging. Radiology 2000; 216: 781–787.
    Google Scholar
  • 6 Kramer CM, Rogers WJ Jr, Pakstis DL. Absence of adverse outcomes after magnetic resonance imaging early after stent placement for acute myocardial infarction: a preliminary study. J Cardiovasc Magn Reson 2000; 2: 257–261.
    Medline Google Scholar
  • 7 Jeremias A, Sylvia B, Bridges J, et al. Stent thrombosis after successful sirolimus-eluting stent implantation. Circulation 2004; 109: 1930–1932.
    Medline Google Scholar
  • 8 Regar E, Lemos PA, Saia F, et al. Incidence of thrombotic stent occlusion during the first 3 months after sirolimus-eluting stent implantation in 500 consecutive patients. Am J Cardiol 2004; 93: 1271–1275.
    Medline Google Scholar
  • 9 Kim RJ, Fieno DS, Parrish TB, et al. Relationship of MR imaging delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation 1999; 100: 1992–2002.
    Medline Google Scholar
  • 10 Simonetti OP, Kim RJ, Fieno DS, et al. An improved MR imaging technique for the visualization of myocardial infarction. Radiology 2001; 218: 215–223.
    Google Scholar
  • 11 Kim RJ, Wu E, Rafael A, et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 2000; 343: 1445–1453.
    Medline Google Scholar
  • 12 Kagetsu NJ, Litt AW. Important considerations in measurement of attractive force on metallic implants in MR imagers. Radiology 1991; 179: 505–508.
    Google Scholar
  • 13 Driver over-the-wire coronary stent system [package insert]. Minneapolis, Minn: Medtronic, 2003.
    Google Scholar
  • 14 Shellock FG, Morisoli S, Kanal E. MR procedures and biomedical implants, materials, and devices: 1993 update. Radiology 1993; 189: 587–599.
    Google Scholar
  • 15 Express-2 monorail coronary stent delivery system [package insert]. Natick, Mass: Boston Scientific, 2002.
    Google Scholar
  • 16 Multi-link pixel coronary stent systems [package insert]. Natick, Mass: Guidant/Boston Scientific, 2003.
    Google Scholar
  • 17 TAXUS: paclitaxel-eluting coronary stent system [package insert]. Natick, Mass: Boston Scientific, 2004.
    Google Scholar
  • 18 CYPHER: sirolimus eluting coronary stent system [package insert]. Miami Lakes, Fla: Cordis, 2004.
    Google Scholar
  • 19 Gerber TC, Fasseas P, Lennon RJ, et al. Clinical safety of magnetic resonance imaging early after coronary artery stent placement. J Am Coll Cardiol 2003; 42: 1295–1298.
    Medline Google Scholar
  • 20 Kerner A, Gruberg L, Kapeliovich M, Grenadier E. Late stent thrombosis after implantation of a sirolimus-eluting stent. Catheter Cardiovasc Interv 2003; 60: 505–508.
    Medline Google Scholar
  • 21 Virmani R, Guagliumi G, Farb A, et al. Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent: should we be cautious? Circulation 2004; 109: 701–705.
    Google Scholar
  • 22 Liistro F, Colombo A. Late acute thrombosis after paclitaxel eluting stent implantation. Heart 2001; 86: 262–264.
    Medline Google Scholar
  • 23 McFadden EP, Stabile E, Regar E, et al. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet 2004; 364: 1519–1521.
    Medline Google Scholar
  • 24 Amado LC, Gerber BL, Gupta SN, et al. Accurate and objective infarct sizing by contrast-enhanced magnetic resonance imaging in a canine myocardial infarction model. J Am Coll Cardiol 2004; 44: 2383–2389.
    Medline Google Scholar
  • 25 Lima JA, Judd RM, Bazille A, Schulman SP, Atalar E, Zerhouni EA. Regional heterogeneity of human myocardial infarcts demonstrated by contrast-enhanced MRI: potential mechanisms. Circulation 1995; 92(5): 1117–1125.
    Google Scholar
  • 26 Hillenbrand HB, Kim RJ, Parker MA, Fieno DS, Judd RM. Early assessment of myocardial salvage by contrast-enhanced magnetic resonance imaging. Circulation 2000; 102: 1678–1683.
    Medline Google Scholar
  • 27 Ricciardi MJ, Wu E, Davidson CJ, et al. Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. Circulation 2001; 103: 2780–2783.
    Medline Google Scholar
  • 28 Wollert KC, Meyer GP, Lotz J, et al. Intracoronary autologous bone-marrow cell transfer after myocardial infarction: the BOOST randomised controlled clinical trial. Lancet 2004; 364: 141–148.
    Medline Google Scholar
  • 29 Britten MB, Abolmaali ND, Assmus B, et al. Infarct remodeling after intracoronary progenitor cell treatment in patients with acute myocardial infarction (TOPCARE-AMI): mechanistic insights from serial contrast-enhanced magnetic resonance imaging. Circulation 2003; 108: 2212–2218.
    Medline Google Scholar

Article History

Published in print: 2006