Risk stratification guided by the index of microcirculatory resistance and left ventricular end-diastolic pressure in acute myocardial infarction

Maznyczka, A. M. et al. (2021) Risk stratification guided by the index of microcirculatory resistance and left ventricular end-diastolic pressure in acute myocardial infarction. Circulation: Cardiovascular Interventions, 14(2), e009529. (doi: 10.1161/CIRCINTERVENTIONS.120.009529) (PMID:33591821)

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Background: The index of microcirculatory resistance (IMR) of the infarct-related artery and left ventricular end-diastolic pressure (LVEDP) are acute, prognostic biomarkers in patients undergoing primary percutaneous coronary intervention. The clinical significance of IMR and LVEDP in combination is unknown. Methods: IMR and LVEDP were prospectively measured in a prespecified substudy of the T-TIME clinical trial (Trial of Low Dose Adjunctive Alteplase During Primary PCI). IMR was measured using a pressure- and temperature-sensing guidewire following percutaneous coronary intervention. Prognostically established thresholds for IMR (>32) and LVEDP (>18 mm Hg) were predefined. Contrast-enhanced cardiovascular magnetic resonance imaging (1.5 Tesla) was acquired 2 to 7 days and 3 months postmyocardial infarction. The primary end point was major adverse cardiac events, defined as cardiac death/nonfatal myocardial infarction/heart failure hospitalization at 1 year. Results: IMR and LVEDP were both measured in 131 patients (mean age 59±10.7 years, 103 [78.6%] male, 48 [36.6%] with anterior myocardial infarction). The median IMR was 29 (interquartile range, 17–55), the median LVEDP was 17 mm Hg (interquartile range, 12–21), and the correlation between them was not statistically significant (r=0.15; P=0.087). Fifty-three patients (40%) had low IMR (≤32) and low LVEDP (≤18), 18 (14%) had low IMR and high LVEDP, 31 (24%) had high IMR and low LVEDP, while 29 (22%) had high IMR and high LVEDP. Infarct size (% LV mass), LV ejection fraction, final myocardial perfusion grade ≤1, TIMI (Thrombolysis In Myocardial Infarction) flow grade ≤2, and coronary flow reserve were associated with LVEDP/IMR group, as was hospitalization for heart failure (n=18 events; P=0.045) and major adverse cardiac events (n=21 events; P=0.051). LVEDP>18 and IMR>32 combined was associated with major adverse cardiac events, independent of age, estimated glomerular filtration rate, and infarct-related artery (odds ratio, 5.80 [95% CI, 1.60–21.22] P=0.008). The net reclassification improvement for detecting major adverse cardiac events was 50.6% (95% CI, 2.7–98.2; P=0.033) when LVEDP>18 was added to IMR>32. Conclusions: IMR and LVEDP in combination have incremental value for risk stratification following primary percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02257294.

Item Type:Articles
Glasgow Author(s) Enlighten ID:McConnachie, Professor Alex and Ford, Thomas and Robertson, Dr Keith and Shaukat, Dr Aadil and Rocchiccioli, Dr John and Collison, Dr Damien and McEntegart, Dr Margaret and Gillespie, Dr Lynsey and McCartney, Dr Peter and Oldroyd, Dr Keith and Watkins, Dr Stuart and Hood, Dr Stuart and Berry, Professor Colin and Maznyczka, Dr Annette Marie and Eteiba, Professor Hany
Authors: Maznyczka, A. M., McCartney, P. J., Oldroyd, K. G., Lindsay, M., McEntegart, M., Eteiba, H., Rocchiccioli, J. P., Good, R., Shaukat, A., Robertson, K., Malkin, C. J., Greenwood, J. P., Cotton, J. M., Hood, S., Watkins, S., Collison, D., Gillespie, L., Ford, T. J., Weir, R. A.P., McConnachie, A., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Circulation: Cardiovascular Interventions
Publisher:Lippincott, Williams & Wilkins
ISSN (Online):1941-7632
Published Online:16 February 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Circulation: Cardiovascular Interventions 14(2): e009529
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
174049T-TIME Coronary Physiology StudyColin BerryBritish Heart Foundation (BHF)FS/16/74/32573Institute of Cardiovascular & Medical Sciences
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science
190864A randomised parallel group double blind placebo-controlled trial of low dose adjunctive alteplase during primary PCI (T-TIME)Colin BerryNational Institute for Health Research (NIHR)12/170/45Institute of Cardiovascular & Medical Sciences