Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Circ Cardiovasc Interv. 2013 Jun;6(3):207-15. doi: 10.1161/CIRCINTERVENTIONS.112.000168. Epub 2013 Jun 4.
Microvascular function is increasingly being recognized as an important marker of risk in coronary artery disease, and may be accurately assessed by intracoronary Doppler flow velocity measurements. In the setting of ST-segment-elevation myocardial infarction there are limited data regarding the prognostic value of microvascular function in both infarct-related and reference coronary arteries for long-term clinical outcome. We sought to determine the prognostic value of microvascular function, as assessed by Doppler flow velocity measurements, for cardiac mortality after primary percutaneous coronary intervention for acute ST-segment-elevation myocardial infarction.
Between April 1997 and August 2000, we included 100 consecutive patients with a first anterior wall ST-segment-elevation myocardial infarction. Immediately after primary percutaneous coronary intervention, intracoronary Doppler flow velocity was measured in the infarct-related artery, to determine coronary flow velocity reserve (CFVR), diastolic deceleration time, and the presence of systolic retrograde flow, as well as in a reference vessel to determine reference vessel CFVR. The primary end point was cardiac mortality at 10-year follow-up. Complete follow-up was obtained in 94 patients (94%). At 10-year follow-up, cardiac mortality amounted to 14%. Cardiac mortality amounted to 5% when reference vessel CFVR was normal (≥2.1), in contrast to 31% when abnormal (<2.1; P=0.001). Reference vessel CFVR <2.1 was associated with a 4.09 increase in long-term cardiac mortality hazard after multivariate adjustment for identified predictors for cardiac mortality (hazard ratio, 4.09; 95% confidence interval, 1.18-14.17; P=0.03) CONCLUSIONS: Microvascular dysfunction, measured by reference vessel CFVR determined after primary percutaneous coronary intervention for acute anterior wall ST-segment-elevation myocardial infarction is associated with a significantly increased long-term cardiac mortality.
微血管功能越来越被认为是冠心病的一个重要危险标志物，并且可以通过冠状动脉内多普勒血流速度测量来准确评估。在 ST 段抬高型心肌梗死的情况下，关于梗死相关和参考冠状动脉的微血管功能对长期临床结果的预后价值的数据有限。我们旨在确定通过多普勒血流速度测量评估的微血管功能对急性 ST 段抬高型心肌梗死经皮冠状动脉介入治疗后心脏死亡率的预后价值。
1997 年 4 月至 2000 年 8 月，我们纳入了 100 例连续的前壁 ST 段抬高型心肌梗死的患者。在经皮冠状动脉介入治疗后立即，在梗死相关动脉内测量冠状动脉血流储备（CFVR）、舒张减速时间和收缩期逆行血流的存在，以及在参考血管内测量参考血管 CFVR。主要终点是 10 年随访时的心脏死亡率。94 例患者（94%）获得了完整的随访。在 10 年随访时，心脏死亡率为 14%。当参考血管 CFVR 正常（≥2.1）时，心脏死亡率为 5%，而当异常（<2.1）时，心脏死亡率为 31%（P=0.001）。在多变量校正识别的心脏死亡率预测因素后，参考血管 CFVR <2.1 与长期心脏死亡率危险增加 4.09 相关（危险比，4.09；95%置信区间，1.18-14.17；P=0.03）。
急性前壁 ST 段抬高型心肌梗死经皮冠状动脉介入治疗后，通过参考血管 CFVR 测量的微血管功能障碍与长期心脏死亡率显著增加相关。
