Comparison of magnetic resonance imaging findings in non-ST-segment elevation versus ST-segment elevation myocardial infarction patients undergoing early invasive intervention

  • Jianqiang Xu
  • Young Bin Song
  • Joo-Yong Hahn
  • Sung-A Chang
  • Sang-Chol Lee
  • Yeon Hyeon Choe
  • Seung-Hyuk Choi
  • Jin-Ho Choi
  • Sang Hoon Lee
  • Jae K. Oh
  • Hyeon-Cheol Gwon
Original Paper


To define causes and pathological mechanisms underlying differences in clinical outcomes, we compared the findings of contrast-enhanced magnetic resonance imaging (CE-MRI) between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). In 168 patients undergoing early invasive intervention for STEMI (n = 113) and NSTEMI (n = 55), CE-MRI was performed a median of 6 days after the index event. Infarct size was measured on delayed-enhancement imaging, and area at risk (AAR) was quantified on T2-weighted images. The median infarct size was significantly smaller in the NSTEMI group than in the STEMI group (10.7% [5.6–18.1] vs. 19.2% [10.3–30.7], P < 0.001). Although there was a trend toward a greater myocardial salvage index ([AAR − infarct size] × 100/AAR) in the NSTEMI group compared to the STEMI group (48.2 [30.4–66.8] vs. 40.5 [24.8–53.5], P = 0.056), myocardial salvage index was similar between the groups in patients with anterior infarction (39.6 [20.0–54.9] vs. 35.5 [23.2–53.4], P = 0.96). The NSTEMI group also had a significantly lower extent of microvascular obstruction and a smaller number of segments with >75% of infarct transmurality relative to the STEMI group (0% [0–0.6] vs. 0.9% [0–2.3], P < 0.001 and 3.0 ± 2.3 vs. 4.6 ± 2.9, P = 0.001, respectively). Myocardial hemorrhage was detected less frequently in the NSTEMI group than the STEMI group (22.6% vs. 43.8%, P = 0.029). In the multivariate analysis, baseline Thrombolysis In Myocardial Infarction flow grade 3 and hemorrhagic infarction were closely associated with ST-segment elevation (OR 0.32, 95% CI 0.13–0.81, P = 0.017; OR 5.66, 95% CI 1.77–18.12, P = 0.003, respectively). In conclusion, in vivo pathophysiological differences revealed by CE-MRI assessment include more favorable infarct size, AAR, myocardial salvage and reperfusion injury in patients with NSTEMI compared to those with STEMI undergoing early invasive intervention.


Acute myocardial infarction Magnetic resonance imaging 



This work was supported by a grant from the IN-SUNG Foundation for Medical Research, Republic of Korea (grant number; CA88331).

Conflict of interest



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Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Jianqiang Xu
    • 1
    • 2
  • Young Bin Song
    • 1
  • Joo-Yong Hahn
    • 1
  • Sung-A Chang
    • 1
    • 3
  • Sang-Chol Lee
    • 1
    • 3
  • Yeon Hyeon Choe
    • 3
    • 4
  • Seung-Hyuk Choi
    • 1
  • Jin-Ho Choi
    • 1
  • Sang Hoon Lee
    • 1
  • Jae K. Oh
    • 3
    • 5
  • Hyeon-Cheol Gwon
    • 1
  1. 1.Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  2. 2.Department of Cardiology, Tianjin First Central HospitalTianjin Medical UniversityTianjinChina
  3. 3.Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  4. 4.Department of Radiology, Samsung Medical CentreSungkyunkwan University School of MedicineSeoulRepublic of Korea
  5. 5.Division of Cardiovascular DiseaseMayo Clinic College of MedicineRochesterUSA

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