Flores Cristian Herrera, Díez-Delhoyo Felipe, Sanz-Ruiz Ricardo, Vázquez-Álvarez María Eugenia, Tamargo Delpon María, Soriano Triguero Javier, Elízaga Corrales Jaime, Fernández-Avilés Francisco, Gutiérrez Ibañes Enrique
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red - Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain.
Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Int J Cardiol Heart Vasc. 2022 Mar 15;39:100997. doi: 10.1016/j.ijcha.2022.100997. eCollection 2022 Apr.
Endothelial and microvascular dysfunction are frequently found in the non-culprit territory in patients with acute myocardial infarction (AMI). We aimed to determine whether an impaired coronary physiology of the non-culprit territory impacts long-term prognosis.
FISIOIAM was an observational single-center study which included patients with AMI and another coronary artery lesion in a different territory. Intracoronary physiology of the non-culprit artery was analyzed early after primary percutaneous coronary intervention of the culprit artery, using fractional flow reserve (FFR), index of microcirculatory resistance (IMR), coronary flow reserve (CFR), endothelium-dependent CFR (eCFR) and macrovascular endothelial function . Patients were followed for a composite outcome of cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and hospitalization due to heart failure or unstable angina.
A total of 84 patients (mean age: 62 ± 10 years) were included and functional abnormalities were detected in 93% of them. During follow-up (median of 1422 days; interquartile range, 1287-1634), 13.1% of the patients experienced at least one adverse cardiovascular event. Kaplan-Meier analysis revealed that patients with a CFR < 2 had a higher risk of events (Hazard Ratio, HR: 4.97, 95% Confidence Interval, CI, 1.32-18.75), whereas other parameters such as FFR, IMR, eCFR, and macrovascular endothelial function had no effect. A low CFR was an independent predictor of cardiovascular events, even after adjustment for age and traditional cardiovascular risk factors (adjusted HR: 6.62, 95% CI, 1.30-33.70).
The presence of abnormal coronary microvascular function as measured by a CFR < 2 in the non-culprit territory predicts future risk of adverse cardiovascular events.
急性心肌梗死（AMI）患者的非罪犯血管区域常出现内皮功能和微血管功能障碍。我们旨在确定非罪犯血管区域受损的冠状动脉生理功能是否会影响长期预后。
FISIOIAM是一项单中心观察性研究，纳入了患有AMI且在不同区域存在另一处冠状动脉病变的患者。在对罪犯血管进行直接经皮冠状动脉介入治疗后早期，使用血流储备分数（FFR）、微循环阻力指数（IMR）、冠状动脉血流储备（CFR）、内皮依赖性CFR（eCFR）和大血管内皮功能分析非罪犯血管的冠状动脉生理功能。对患者进行随访，观察心血管死亡、非致命性心肌梗死、冠状动脉血运重建以及因心力衰竭或不稳定型心绞痛住院的复合结局。
共纳入84例患者（平均年龄：62±10岁），其中93%检测到功能异常。在随访期间（中位数为1422天；四分位间距，1287 - 1634），13.1%的患者发生了至少一次不良心血管事件。Kaplan - Meier分析显示，CFR<2的患者发生事件的风险更高（风险比，HR：4.97，95%置信区间，CI，1.32 - 18.75），而其他参数如FFR、IMR、eCFR和大血管内皮功能则无影响。即使在调整年龄和传统心血管危险因素后，低CFR仍是心血管事件的独立预测因素（调整后HR：6.62，95%CI，1.30 - 33.70）。
非罪犯血管区域中通过CFR<测得的冠状动脉微血管功能异常预示着未来发生不良心血管事件的风险。 （注：原文此处“CFR<”后面似乎缺少具体数值）
