Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction

Carrick, D. et al. (2016) Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction. JCI Insight, 1(6), e85768. (doi:10.1172/jci.insight.85768) (PMID:27699259) (PMCID:PMC5033815)

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Abstract

BACKGROUND. Failed myocardial reperfusion is common and prognostically important after acute ST-elevation myocardial infarction (STEMI). The purpose of this study was to investigate coronary flow reserve (CFR), a measure of vasodilator capacity, and the index of microvascular resistance (IMR; mmHg × s) in the culprit artery of STEMI survivors. METHODS. IMR (n = 288) and CFR (n = 283; mean age [SD], 60 [12] years) were measured acutely using guide wire–based thermodilution. Cardiac MRI disclosed left ventricular pathology, function, and volumes at 2 days (n = 281) and 6 months after STEMI (n = 264). All-cause death or first heart failure hospitalization was independently adjudicated (median follow-up 845 days). RESULTS. Myocardial hemorrhage and microvascular obstruction occurred in 89 (42%) and 114 (54%) patients with evaluable T2*-MRI maps. IMR and CFR were associated with microvascular pathology (none vs. microvascular obstruction only vs. microvascular obstruction and myocardial hemorrhage) (median [interquartile range], IMR: 17 [12.0–33.0] vs. 17 [13.0–39.0] vs. 37 [21.0–63.0], P < 0.001; CFR: 1.7 [1.4–2.5] vs. 1.5 [1.1–1.8] vs. 1.4 [1.0–1.8], P < 0.001), whereas thrombolysis in myocardial infarction blush grade was not. IMR was a multivariable associate of changes in left ventricular end-diastolic volume (regression coefficient [95% CI] 0.13 [0.01, 0.24]; P = 0.036), whereas CFR was not (P = 0.160). IMR (5 units) was a multivariable associate of all-cause death or heart failure hospitalization (n = 30 events; hazard ratio [95% CI], 1.09 [1.04, 1.14]; P < 0.001), whereas CFR (P = 0.124) and thrombolysis in myocardial infarction blush grade (P = 0.613) were not. IMR had similar prognostic value for these outcomes as <50% ST-segment resolution on the ECG. CONCLUSIONS. IMR is more closely associated with microvascular pathology, left ventricular remodeling, and health outcomes than the angiogram or CFR.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Welsh, Dr Paul and Carrick, Dr David and Petrie, Professor Mark and Mccartney, Dr Peter and Rauhalammi, Mr Samuli and Oldroyd, Dr Keith and Ford, Professor Ian and Hood, Dr Stuart and Berry, Professor Colin and Eteiba, Dr Hany and Haig, Dr Caroline and Sattar, Professor Naveed and Mordi, Dr Ify and Radjenovic, Dr Aleksandra and Ahmed, Mr Nadeem
Authors: Carrick, D., Haig, C., Carberry, J., Teng Tue May, V., Mccartney, P., Welsh, P., Ahmed, N., McEntegart, M., Petrie, M. C., Eteiba, H., Lindsay, M., Hood, S., Watkins, S., Mahrous, A., Rauhalammi, S. M.O., Mordi, I., Ford, I., Radjenovic, A., Sattar, N., Oldroyd, K. G., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:JCI Insight
Publisher:American Society for Clinical Investigation
ISSN:2379-3708
Copyright Holders:Copyright © 2016 American Society for Clinical Investigation
First Published:First published in JCI Insight 1(6): e85768
Publisher Policy:Reproduced under a Creative Commons License
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