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

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 ×...

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Autores principales: Carrick, David, Haig, Caroline, Carberry, Jaclyn, May, Vannesa Teng Yue, McCartney, Peter, Welsh, Paul, Ahmed, Nadeem, McEntegart, Margaret, Petrie, Mark C., Eteiba, Hany, Lindsay, Mitchell, Hood, Stuart, Watkins, Stuart, Mahrous, Ahmed, Rauhalammi, Samuli M.O., Mordi, Ify, Ford, Ian, Radjenovic, Aleksandra, Sattar, Naveed, Oldroyd, Keith G., Berry, Colin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society for Clinical Investigation 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5033815/
https://www.ncbi.nlm.nih.gov/pubmed/27699259
http://dx.doi.org/10.1172/jci.insight.85768
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author Carrick, David
Haig, Caroline
Carberry, Jaclyn
May, Vannesa Teng Yue
McCartney, Peter
Welsh, Paul
Ahmed, Nadeem
McEntegart, Margaret
Petrie, Mark C.
Eteiba, Hany
Lindsay, Mitchell
Hood, Stuart
Watkins, Stuart
Mahrous, Ahmed
Rauhalammi, Samuli M.O.
Mordi, Ify
Ford, Ian
Radjenovic, Aleksandra
Sattar, Naveed
Oldroyd, Keith G.
Berry, Colin
author_facet Carrick, David
Haig, Caroline
Carberry, Jaclyn
May, Vannesa Teng Yue
McCartney, Peter
Welsh, Paul
Ahmed, Nadeem
McEntegart, Margaret
Petrie, Mark C.
Eteiba, Hany
Lindsay, Mitchell
Hood, Stuart
Watkins, Stuart
Mahrous, Ahmed
Rauhalammi, Samuli M.O.
Mordi, Ify
Ford, Ian
Radjenovic, Aleksandra
Sattar, Naveed
Oldroyd, Keith G.
Berry, Colin
author_sort Carrick, David
collection PubMed
description 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. TRIAL REGISTRATION. NCT02072850. FUNDING. A British Heart Foundation Project Grant (PG/11/2/28474), the National Health Service, the Chief Scientist Office, a Scottish Funding Council Senior Fellowship, a British Heart Foundation Intermediate Fellowship (FS/12/62/29889), and a nonfinancial research agreement with Siemens Healthcare.
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spelling pubmed-50338152016-10-03 Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction Carrick, David Haig, Caroline Carberry, Jaclyn May, Vannesa Teng Yue McCartney, Peter Welsh, Paul Ahmed, Nadeem McEntegart, Margaret Petrie, Mark C. Eteiba, Hany Lindsay, Mitchell Hood, Stuart Watkins, Stuart Mahrous, Ahmed Rauhalammi, Samuli M.O. Mordi, Ify Ford, Ian Radjenovic, Aleksandra Sattar, Naveed Oldroyd, Keith G. Berry, Colin JCI Insight Clinical Medicine 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. TRIAL REGISTRATION. NCT02072850. FUNDING. A British Heart Foundation Project Grant (PG/11/2/28474), the National Health Service, the Chief Scientist Office, a Scottish Funding Council Senior Fellowship, a British Heart Foundation Intermediate Fellowship (FS/12/62/29889), and a nonfinancial research agreement with Siemens Healthcare. American Society for Clinical Investigation 2016-05-05 /pmc/articles/PMC5033815/ /pubmed/27699259 http://dx.doi.org/10.1172/jci.insight.85768 Text en Copyright © 2016 Carrick et al. http://creativecommons.org/licenses/by/4.0/ This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Clinical Medicine
Carrick, David
Haig, Caroline
Carberry, Jaclyn
May, Vannesa Teng Yue
McCartney, Peter
Welsh, Paul
Ahmed, Nadeem
McEntegart, Margaret
Petrie, Mark C.
Eteiba, Hany
Lindsay, Mitchell
Hood, Stuart
Watkins, Stuart
Mahrous, Ahmed
Rauhalammi, Samuli M.O.
Mordi, Ify
Ford, Ian
Radjenovic, Aleksandra
Sattar, Naveed
Oldroyd, Keith G.
Berry, Colin
Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction
title Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction
title_full Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction
title_fullStr Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction
title_full_unstemmed Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction
title_short Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction
title_sort microvascular resistance of the culprit coronary artery in acute st-elevation myocardial infarction
topic Clinical Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5033815/
https://www.ncbi.nlm.nih.gov/pubmed/27699259
http://dx.doi.org/10.1172/jci.insight.85768
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