Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., M.M.-S., J.B., J.S., J.E., F.F.-A.).
Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., J.S., J.E.).
Circ Cardiovasc Interv. 2019 Feb;12(2):e007257. doi: 10.1161/CIRCINTERVENTIONS.118.007257.
Approximately half of the patients presenting with ST-segment-elevation myocardial infarction (STEMI) have multivessel disease. The physiology of the nonculprit artery has not been thoroughly studied to date. We sought to characterize the coronary physiology of the nonculprit artery in the early phase after STEMI and determine the real prevalence of microvascular and endothelial dysfunction.
Patients with STEMI and another coronary artery lesion in a different territory were prospectively included in an observational single-center study. The protocol took place after revascularization of the culprit artery and comprised 3 phases: first, epicardial endothelial functional assessment using intracoronary acetylcholine; second, epicardial severity quantification based on fractional flow reserve, and nonendothelial microvascular function with coronary flow reserve and the index of microvascular resistance; third, endothelium-dependent microvascular function assessment based on the endothelial coronary flow reserve. Eighty-four patients were included. Mean age was 62±10 years, and 86.9% were men. Only 6 subjects had a nonpathological study: macrovascular endothelial dysfunction was present in 60% of the patients; fractional flow reserve ≤0.8, coronary flow reserve <2, and index of microvascular resistance >25 were evident in 34%, 37%, and 28% of the subjects respectively; and microvascular endothelial dysfunction (endothelial coronary flow reserve <1.5) was observed in 44%. In hospital-mortality was 0%, and no major complications occurred. At 6-month follow-up, there were no events related to the nonculprit artery.
Microvascular and endothelial dysfunction in the nonculprit artery territory in patients with STEMI are very common. In 93% of the patients, we found functional abnormalities. Acetylcholine administration in the early phase post-STEMI in patients with multivessel disease is safe.
大约一半出现 ST 段抬高型心肌梗死（STEMI）的患者存在多支血管病变。迄今为止，尚未对非罪犯动脉的生理学进行深入研究。我们旨在描述 STEMI 后早期非罪犯动脉的冠状动脉生理学，并确定微血管和内皮功能障碍的真实患病率。
前瞻性纳入了一项多中心观察性研究中出现 STEMI 合并另一支不同部位冠状动脉病变的患者。该方案在罪犯动脉血运重建后进行，包括 3 个阶段：首先，通过冠状动脉内乙酰胆碱评估心外膜内皮功能；其次，根据血流储备分数评估心外膜严重程度，并通过冠状动脉血流储备和微血管阻力指数评估非内皮微血管功能；最后，通过内皮依赖性冠状动脉血流储备评估内皮微血管功能。共纳入 84 例患者。平均年龄为 62±10 岁，86.9%为男性。仅有 6 例患者的研究结果正常：60%的患者存在大血管内皮功能障碍；34%、37%和 28%的患者血流储备分数≤0.8、冠状动脉血流储备<2 和微血管阻力指数>25；44%的患者存在微血管内皮功能障碍（内皮依赖性冠状动脉血流储备<1.5）。住院期间死亡率为 0%，无重大并发症发生。在 6 个月的随访中，非罪犯动脉未发生相关事件。
STEMI 患者非罪犯动脉区域的微血管和内皮功能障碍非常常见。在 93%的患者中，我们发现了功能异常。在多支血管病变的 STEMI 患者中，早期给予乙酰胆碱是安全的。
