评估冠状动脉微血管阻力的全血管造影衍生方法与血管造影和压力导丝衍生方法相结合的混合方法的比较：牛津急性心肌梗死混合（OxAMI-HYBRID）研究。
Comparison of a Fully Angiography-Derived Versus a Hybrid of Angiography and Pressure-Wire-Derived Approach to Assess Coronary Microvascular Resistance: The Oxford Acute Myocardial Infarction Hybrid (OxAMI-HYBRID) Study.
作者信息
Chai Jason, Marin Federico, Scarsini Roberto, Kotronias Rafail, Benenati Stefano, Chu Miao, Couch Liam S, Langrish Jeremy, Channon Keith, Banning Adrian, De Maria Giovanni Luigi
机构信息
Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
Department of Internal Medicine (Di.M.I.), University of Genoa, Genoa, Italy.
出版信息
Catheter Cardiovasc Interv. 2025 Jan;105(1):81-90. doi: 10.1002/ccd.31311. Epub 2024 Nov 24.
BACKGROUND
Despite growing evidence of its clinical implications, assessment of coronary microvascular dysfunction (CMD) remains limited in routine clinical practice. Hence, there is an increasing interest in angiography-derived indices to encourage assessment of CMD in the cardiac catheterisation laboratory.
AIMS
We investigate here an alternative approach, using a combination of pressure-wire-based assessment of distal coronary pressure (P) and an angiography-derived surrogate of coronary flow, to derive a hybrid index of microcirculatory resistance (IMR).
METHODS
Patients enroled prospectively under the Oxford Acute Myocardial Infarction (OxAMI) study were included in the OxAMI HYBRID substudy. The accuracy of IMR was assessed in diagnosing CMD using bolus thermodilution-based Index of Microcirculatory Resistance (IMR) as a reference. The accuracy of IMR was then compared against a fully angiography-derived index of microvascular resistance (IMR).
RESULTS
One hundred and eighty six patients were enroled, of which 121 with acute coronary syndrome and 65 with stable coronary artery disease. A total of 240 vessel analyses were performed. Both IMR and IMR correlated with IMR (rho = 0.71, p < 0.001 and rho = 0.71, p < 0.001 respectively) and showed good and comparable overall diagnostic accuracy in predicting IMR ≥ 25 (80.8% and 83.1% respectively) with a receiver operator curve (ROC) analyses showing similar AUC of 0.86 (95% CI 0.82-0.91, p < 0.001) for IMR and 0.86 (95% CI 0.809-0.906, p < 0.001) for IMR, p for comparison = 0.641.
CONCLUSION
Both approaches, IMR and IMR are viable and comparable indices correlating with bolus thermodilution-based IMR and retaining good diagnostic accuracy. IMR specifically is a simple alternative to conventional bolus thermodilution-based IMR applicable to any pressure wire system.
背景
尽管有越来越多的证据表明其具有临床意义，但在常规临床实践中，对冠状动脉微血管功能障碍（CMD）的评估仍然有限。因此，人们对血管造影衍生指标的兴趣日益浓厚，以促进在心脏导管实验室中对CMD的评估。
目的
我们在此研究一种替代方法，结合基于压力导丝的冠状动脉远端压力（P）评估和血管造影衍生的冠状动脉血流替代指标，得出微循环阻力混合指数（IMR）。
方法
前瞻性纳入牛津急性心肌梗死（OxAMI）研究的患者被纳入OxAMI HYBRID子研究。以基于团注热稀释的微循环阻力指数（IMR）为参考，评估IMR在诊断CMD方面的准确性。然后将IMR的准确性与完全基于血管造影的微血管阻力指数（IMR）进行比较。
结果
共纳入186例患者，其中121例患有急性冠状动脉综合征，65例患有稳定型冠状动脉疾病。总共进行了240次血管分析。IMR和IMR均与IMR相关（分别为rho = 0.71，p < 0.001和rho = 0.71，p < 0.001），并且在预测IMR≥25时显示出良好且可比的总体诊断准确性（分别为80.8%和83.1%），受试者工作特征曲线（ROC）分析显示IMR的曲线下面积（AUC）为0.86（95%可信区间0.82 - 0.91，p < 0.001），IMR的AUC为0.86（95%可信区间0.809 - 0.906，p < 0.001），比较的p值 = 0.641。
结论
IMR和IMR这两种方法都是可行且可比的指标，与基于团注热稀释的IMR相关，并且保持良好的诊断准确性。特别是IMR是适用于任何压力导丝系统的传统基于团注热稀释的IMR的简单替代方法。
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