NONINVASIVE DETERMINATION OF INFARCT ARTERY PATENCY BY CINE MAGNETIC-RESONANCE ANGIOGRAPHY

Background In survivors of myocardial infarction, restoration of anteg rade flow in the infarct artery reduces morbidity and mortality. At pr esent, coronary artery patency must be assessed invasively with contra st angiography. A noninvasive method of evaluating infarct artery pate ncy would be useful in managing survivors of infarction. This study wa s performed to determine whether magnetic resonance (MR) imaging could reliably assess infarct artery patency in this patient population. Me thods and Results Eighteen survivors of myocardial infarction (11 men and 7 women, aged 35 to 74 years) who were consecutively referred for cardiac catheterization underwent contrast coronary angiography and ci ne MR coronary angiography. Sequential overlapping images of the infar ct artery were acquired with cine MR during 15- to 20-second periods o f breath-holding. In each study, proximal, middle, and distal segments of infarct arteries were classified as having antegrade, collateral, or no flow. The infarct artery was the left anterior descending in 10 patients, the right anterior descending in 7, acid the circumflex in 1 . When compared with the results of contrast angiography, MR imaging c orrectly identified the presence or absence of antegrade flow in the i nfarct artery of all 18 patients. In addition, cine MR coronary angiog raphy with presaturating pulses correctly established the presence or absence of collateral filling of the distal portion of occluded arteri es in 6 of 7 subjects. Conclusions In survivors of myocardial infarcti on, cine MR coronary angiography can reliably determine the patency an d direction of flow in the infarct artery.