The Impact of Microvascular Resistance Reserve on the Outcome of Patients With STEMI.
JACC Cardiovasc Interv
; 17(10): 1214-1227, 2024 May 27.
Article
em En
| MEDLINE
| ID: mdl-38752970
ABSTRACT
BACKGROUND:
Microvascular resistance reserve (MRR) can characterize coronary microvascular dysfunction (CMD); however, its prognostic impact in ST-segment elevation myocardial infarction (STEMI) patients remains undefined.OBJECTIVES:
This study sought to investigate the prevalence of CMD in STEMI patients and to elucidate the prognostic performance of MRR.METHODS:
This prospective cohort study enrolled 210 STEMI patients with multivessel disease who underwent successful revascularization and returned at 3 months for coronary physiology assessments with bolus thermodilution. The prevalence of CMD (MRR <3) and the association between MRR and major adverse cardiovascular and cerebrovascular events (MACCEs) at 12 months were investigated.RESULTS:
The median age of patients was 65 years, and 59.5% were men. At the 3-month follow-up, 56 patients (27%) had CMD (MRR <3.0). The number of MACCEs at 12 months was higher in patients with vs without CMD (48.2% vs 11.0%; P < 0.001). MRR was independently associated with 12-month MACCEs (HR 0.45 per unit increase; 95% CI 0.31-0.67; P < 0.001) and with stroke, heart failure, and poorer recovery in left ventricular systolic function. The areas under the receiver-operating characteristic curves for predicting MACCEs at 12 months with fractional flow reserve, coronary flow reserve (CFR), the index of microvascular resistance (IMR), and MRR were 0.609, 0.762, 0.781, and 0.743, respectively. The prognostic performance of CFR, IMR, and MRR were all comparable.CONCLUSIONS:
The novel parameter MRR is a prognostic marker of MACCEs in STEMI patients with a comparable performance to CFR and IMR. (Impact of TMAO Serum Levels on Hyperemic IMR in STEMI Patients [TAMIR]; NCT05406297).Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Termodiluição
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Resistência Vascular
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Doença da Artéria Coronariana
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Valor Preditivo dos Testes
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Circulação Coronária
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Intervenção Coronária Percutânea
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Infarto do Miocárdio com Supradesnível do Segmento ST
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Microcirculação
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
JACC Cardiovasc Interv
Ano de publicação:
2024
Tipo de documento:
Article