Benenati Stefano, Montorfano Matteo, Pica Silvia, Crimi Gabriele, Ancona Marco, Montone Rocco A, Rinaldi Riccardo, Gramegna Mario, Esposito Antonio, Palmisano Anna, Tavano Davide, Monizzi Giovanni, Bartorelli Antonio, Porto Italo, Ambrosio Giuseppe, Camici Paolo Guido
Cardiovascular Disease Chair, Department of Internal Medicine (Di.M.I.), University of Genova, Genova, Liguria, Italy.
Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK.
Heart. 2024 Jan 29;110(4):271-280. doi: 10.1136/heartjnl-2023-323169.
To ascertain whether invasive assessment of coronary physiology soon after recanalisation of the culprit artery by primary percutaneous coronary intervention is associated with the development of microvascular obstruction by cardiac magnetic resonance in patients with ST-segment elevation myocardial infarction (STEMI).
Between November 2020 and December 2021, 102 consecutive patients were prospectively enrolled in five tertiary centres in Italy. Coronary flow reserve (CFR) and index of microvascular resistance (IMR) were measured in the culprit vessel soon after successful primary percutaneous coronary intervention. Optimal cut-off points of IMR and CFR to predict the presence of microvascular obstruction were estimated, stratifying the population accordingly in four groups. A comparison with previously proposed stratification models was carried out.
IMR31 units and CFR≤1.25 yielded the best accuracy. Patients with IMR>31 and CFR≤1.25 exhibited higher microvascular obstruction prevalence (83% vs 38%, p<0.001) and lower left ventricular ejection fraction (45±9% vs 52±9%, p=0.043) compared with those with IMR≤31 and CFR>1.25, and lower left ventricular ejection fraction compared with patients with CFR≤1.25 and IMR≤31 (45±9% vs 54±7%, p=0.025). Infarct size and area at risk were larger in the former, compared with other groups.
IMR and CFR are associated with the presence of microvascular obstruction in STEMI. Patients with an IMR>31 units and a CFR≤1.25 have higher prevalence of microvascular obstruction, lower left ventricular ejection fraction, larger infarct size and area at risk.
NCT04677257.
确定在ST段抬高型心肌梗死（STEMI）患者中，经皮冠状动脉介入治疗开通罪犯血管后不久进行冠状动脉生理学的有创评估是否与心脏磁共振显示的微血管阻塞的发生有关。
2020年11月至2021年12月期间，意大利五个三级中心前瞻性纳入了102例连续患者。在成功进行直接经皮冠状动脉介入治疗后不久，测量罪犯血管的冠状动脉血流储备（CFR）和微血管阻力指数（IMR）。估计IMR和CFR预测微血管阻塞存在的最佳切点，并据此将人群分为四组。与先前提出的分层模型进行比较。
IMR>31单位和CFR≤1.25产生了最佳准确性。与IMR≤31且CFR>1.25的患者相比，IMR>31且CFR≤1.25的患者微血管阻塞患病率更高（83%对38%，p<0.001），左心室射血分数更低（45±9%对52±9%，p=0.043），与CFR≤1.25且IMR≤31的患者相比左心室射血分数更低（45±9%对54±7%，p=0.025）。与其他组相比，前者的梗死面积和危险区域更大。
IMR和CFR与STEMI患者微血管阻塞的存在有关。IMR>31单位且CFR≤1.25的患者微血管阻塞患病率更高，左心室射血分数更低，梗死面积和危险区域更大。
NCT04677257。
