Predictors and Prognostic value of Coronary Computed Tomography Angiography for Unrecognized Myocardial Infarction in Patients with Chronic Coronary Syndrome

Abstract Purpose: Unrecognized myocardial infarction (UMI) detected by delayed-enhancement cardiac magnetic resonance imaging (DE-CMR) and coronary computed tomography angiographic (CCTA)-derived high-risk features provide prognostic information in patients with chronic coronary syndrome (CCS). However, the relationship between UMI and CCTA-derived characteristics remains elusive. The aim of this study is to assess the prognostic value of UMI on DE-CMR and predictors of UMI using CCTA in patients with CCS. Methods: 181 CCS patients without prior history of myocardial infarction and coronary intervention who underwent both DE-CMR and CCTA before elective PCI were enrolled. The CCTA-derived predictors of UMI and the association of baseline clinical characteristics, CCTA findings, and CMR-derived factors with major adverse cardiovascular events (MACE), defined as death, nonfatal myocardial infarction, unplanned late revascularization, hospitalization for congestive heart failure, and stroke were investigated. Results: UMI was detected in 57 patients (31.5%). ROC analysis revealed the optimal cut-off values of Agastson score and mean pericoronary adipose tissue index (FAI) for predicting the presence of UMI were 397 and − 69.8, respectively. Left ventricular mass, Agatston score > 397, mean FAI >-69.8, positive remodeling of the target lesion, and CCTA-derived stenosis severity were independent predictors of UMI. Patients with UMI were associated with worse prognosis. The risk of MACE significantly increased according to the number of 4 preprocedural CCTA relevant features of UMI. Conclusion 57 patients (31.5%) showed UMI. Preprocedural comprehensive CCTA analysis may help predict the presence of UMI and provide prognostic information in patients with CCS undergoing PCI.