Background—: The aim of this study was to assess whether deferred stenting (DS) reduces infarct size and microvascular obstruction (MVO) compared with immediate stenting (IS) in primary percutaneous coronary intervention for ST-segment–elevation myocardial infarction. Methods and Results—: From February 2013 to August 2015, 114 patients (mean age: 69 years) were randomized into the following 2 groups: DS with an intention to stent 3 to 7 days later or IS after primary reperfusion in 2 centers. The primary and secondary end points were infarct size and the incidence of MVO, respectively, assessed by cardiac magnetic resonance imaging at 30 days after primary reperfusion. The median time to the second procedure in the DS was 72.8 hours. Six patients in the DS group were crossed over to the IS group because of progression of dissection or safety concerns after randomization. In the intention-to-treat analysis, DS did not significantly reduce infarct size (15.0% versus 19.4%; P =0.112) and the incidence of MVO (42.6% versus 57.4%; P =0.196), compared with IS. However, in anterior wall myocardial infarction, infarct size (16.1% versus 22.7%; P =0.017) and the incidence of MVO (43.8% versus 70.3%; P =0.047) were significantly reduced in the DS group. There was no urgent revascularization event during deferral period. Conclusions—: A routine DS did not significantly reduce infarct size and MVO compared with IS, although it was safe. The beneficial effect of DS in patients with anterior myocardial infarction should be confirmed by larger randomized studies. Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT02324348.

To evaluate whether the extracellular volume fraction (ECV) measured using cardiac magnetic resonance (CMR) imaging can detect myocardial tissue changes in dilated cardiomyopathy (DCM) without late gadolinium enhancement (LGE). Forty-one DCM patients and 10 healthy volunteers underwent pre- and post-T1 mapping using a modified Look-Locker Inversion recovery sequence, LGE, and cine MRI on a 3-T CMR system. LGE-MR findings were used to divide DCM patients into two groups: Group A had no apparent LGE, and Group B had LGE apparent in at least one segment. The ECV of the left ventricle (LV) myocardium (16 segments) was calculated in the short-axis view as follows: ECV = [(ΔR1 of myocardium/ΔR1 of LV blood pool)] × (1 − hematocrit), where R1 = 1/T1, ΔR1 = post-contrast R1 − pre-contrast R1. The LV ejection fraction (LVEF) was obtained from cine MRI images. The mean myocardial ECV in LGE (−) segments in Group A + B was compared to that of controls. The mean myocardial ECV in Group A was compared to that of LGE (−) segments in Group B. The correlation between LV systolic function and the mean myocardial ECV of the whole myocardium was evaluated in all groups. Among the 41 DCM patients, 22 were in Group A, and 19 were in Group B. The mean ECV of DCM patents (n = 41, 568 segments, 30.7 % ± 5.9) was significantly higher (P < 0.001) than that of the control group (n = 10, 157 segments, 25.6 % ± 3.2). The ECV was inversely related to LVEF in Group A (r = −0.551, P = 0.008), Group B (r = −0.525, P = 0.021), and Group A + B (r = −0.550, P < 0.001). The ECV measured by MRI could be a useful parameter in evaluating diffuse myocardial changes in DCM patients.

The Coronary Artery Disease Reporting and Data System score has incremental prognostic value compared with coronary artery calcium score in predicting future major adverse cardiovascular events in ... Background The Coronary Artery Disease Reporting and Data System (CAD-RADS) was established in 2016 to standardize the reporting of coronary artery disease at coronary CT angiography (CCTA). Purpos...