Prognostic value of the index of microcirculatory resistance measured after primary percutaneous coronary intervention

Fearon, W. F., Low, A. F., Yong, A. S., McGeoch, R., Berry, C. , Shah, M. G., Ho, M. Y., Kim, H.-S., Loh, J. P. and Oldroyd, K. G. (2013) Prognostic value of the index of microcirculatory resistance measured after primary percutaneous coronary intervention. Circulation, 127(24), pp. 2436-2441. (doi:10.1161/CIRCULATIONAHA.112.000298)

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Publisher's URL: http://dx.doi.org/10.1161/CIRCULATIONAHA.112.000298

Abstract

Background — Most methods for assessing microvascular function are not readily available in the cardiac catheterization laboratory. The aim of this study is to determine whether the Index of Microcirculatory Resistance (IMR), measured at the time of primary percutaneous coronary intervention, is predictive of death and rehospitalization for heart failure.

Methods and Results — IMR was measured immediately after primary percutaneous coronary intervention in 253 patients from 3 institutions with the use of a pressure–temperature sensor wire. The primary end point was the rate of death or rehospitalization for heart failure. The prognostic value of IMR was compared with coronary flow reserve, TIMI myocardial perfusion grade, and clinical variables. The mean IMR was 40.3±32.5. Patients with an IMR >40 had a higher rate of the primary end point at 1 year than patients with an IMR ≤40 (17.1% versus 6.6%; P=0.027). During a median follow-up period of 2.8 years, 13.8% experienced the primary end point and 4.3% died. An IMR >40 was associated with an increased risk of death or rehospitalization for heart failure (hazard ratio [HR], 2.1; P=0.034) and of death alone (HR, 3.95; P=0.028). On multivariable analysis, independent predictors of death or rehospitalization for heart failure included IMR >40 (HR, 2.2; P=0.026), fractional flow reserve ≤0.8 (HR, 3.24; P=0.008), and diabetes mellitus (HR, 4.4; P<0.001). An IMR >40 was the only independent predictor of death alone (HR, 4.3; P=0.02).

Conclusions —An elevated IMR at the time of primary percutaneous coronary intervention predicts poor long-term outcomes.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Oldroyd, Dr Keith
Authors: Fearon, W. F., Low, A. F., Yong, A. S., McGeoch, R., Berry, C., Shah, M. G., Ho, M. Y., Kim, H.-S., Loh, J. P., and Oldroyd, K. G.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Circulation
Publisher:American Heart Association
ISSN:0009-7322
ISSN (Online):1524-4539
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
544551Validation and significance of myocardial haemorrhage revealed by "bright blood" T2-weighted MRI in heart attack survivors: a prospective cohort study.Colin BerryBritish Heart Foundation (BHF)PG/11/2/28474RI CARDIOVASCULAR & MEDICAL SCIENCES
575371Fractional Flow Reserve versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes: a Developmental Clinical StudyColin BerryBritish Heart Foundation (BHF)PG/11/55/28999RI CARDIOVASCULAR & MEDICAL SCIENCES