1 Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Madrid Spain.
2 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea.
J Am Heart Assoc. 2019 May 7;8(9):e011534. doi: 10.1161/JAHA.118.011534.
Background Concerns exist about reliability of pressure-wire-guided coronary revascularization of non-infarct-related arteries (non- IRA ). We investigated whether physiological assessment of non- IRA during the subacute phase of myocardial infarction might be flawed by microcirculatory dysfunction. Methods and Results We analyzed non- IRA that underwent fractional flow reserve, coronary flow reserve, and the index of microcirculatory resistance assessment. Microcirculation and hyperemic response were evaluated in 49 acute myocardial infarction patients (59 non- IRA ) and compared with a matched control group of 46 stable angina ( SA ) patients (59 vessels). Time between acute myocardial infarction to physiological interrogation was 5.9±2.4 days. Fractional flow reserve was similar in both groups (0.79±0.11 in non- IRA versus 0.80±0.13 in SA vessels, P=0.527). Lower coronary flow reserve values were found in non- IRA compared with SA vessels (1.77 [1.25-2.76] versus 2.44 [1.63-4.00], P=0.018), primarily driven by an increased baseline flow in non- IRA (rest mean transit time 0.58 [0.32-0.83] versus 0.65 s [0.39-1.20], P=0.045), whereas the hyperemic flow was similar (hyperemic mean transit time 0.26 [0.20-0.42] versus 0.26 s [0.18-0.35], P=0.873). No differences were found regarding index of microcirculatory resistance (15.6 [10.4-21.8] in non- IRA versus 16.7 [11.6-23.6] U in SA vessels, P=0.559). During adenosine infusion, the hyperemic response was similar in both groups (non- IRA versus SA vessels) in terms of the resistive reserve ratio (3.1±2.1 versus 3.7±2.2, P=0.118). Conclusions In the subacute phase of myocardial infarction, non- IRA show an increased baseline flow that may cause abnormal coronary flow reserve despite preserved hyperemic flow. In non- IRA , microcirculatory resistance and adenosine-induced hyperemic response are similar to those found in SA patients. From a physiological perspective, these findings support the use of fractional flow reserve to interrogate non- IRA during the subacute phase of myocardial infarction.
对于非梗死相关动脉（non-IRA）的压力导丝指导下的冠状动脉血运重建的可靠性存在担忧。我们研究了在心肌梗死的亚急性期，非 IRA 的生理评估是否可能受到微循环功能障碍的影响。
我们分析了接受了血流储备分数（fractional flow reserve，FFR）、冠状动脉血流储备（coronary flow reserve，CFR）和微血管阻力指数（index of microcirculatory resistance，IMR）评估的非 IRA。在 49 名急性心肌梗死患者（59 支非 IRA）中评估了微循环和充血反应，并与 46 名稳定性心绞痛（stable angina，SA）患者（59 支血管）的匹配对照组进行了比较。急性心肌梗死至生理检查的时间为 5.9±2.4 天。两组的 FFR 相似（非 IRA 为 0.79±0.11，SA 血管为 0.80±0.13，P=0.527）。与 SA 血管相比，非 IRA 的 CFR 值较低（1.77[1.25-2.76]与 2.44[1.63-4.00]，P=0.018），主要是由于非 IRA 的基础流量增加（静息平均通过时间 0.58[0.32-0.83]与 0.65 s[0.39-1.20]，P=0.045），而充血流量相似（充血平均通过时间 0.26[0.20-0.42]与 0.26 s[0.18-0.35]，P=0.873）。在 IMR 方面没有差异（非 IRA 为 15.6[10.4-21.8]，SA 血管为 16.7[11.6-23.6]U，P=0.559）。在腺苷输注期间，两组的充血反应相似（非 IRA 与 SA 血管），在阻力储备比方面（3.1±2.1 与 3.7±2.2，P=0.118）。
在心肌梗死的亚急性期，非 IRA 显示基础流量增加，尽管充血流量正常，但可能导致异常的冠状动脉血流储备。在非 IRA 中，微血管阻力和腺苷诱导的充血反应与 SA 患者相似。从生理角度来看，这些发现支持在心肌梗死的亚急性期使用 FFR 来检查非 IRA。
