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Coronary physiology thresholds associated with microvascular obstruction in myocardial infarction.
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.
Afiliação
  • Benenati S; Cardiovascular Disease Chair, Department of Internal Medicine (Di.M.I.), University of Genova, Genova, Liguria, Italy.
  • Montorfano M; Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK.
  • Pica S; Interventional Cardiology, IRCCS San Raffaele Hospital, Milan, Italy.
  • Crimi G; Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy.
  • Ancona M; Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy.
  • Montone RA; Cardiology, IRCCS San Raffaele Hospital, Milan, Italy.
  • Rinaldi R; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Gramegna M; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.
  • Esposito A; Cardiology, IRCCS San Raffaele Hospital, Milan, Italy.
  • Palmisano A; Diagnostic Radiology, IRCCS San Raffaele Hospital and Vita University San Raffaele, Milan, Italy.
  • Tavano D; Radiology, Università Vita e Salute San Raffaele, Milan, Italy.
  • Monizzi G; IRCCS San Raffaele Hospital, Milan, Italy.
  • Bartorelli A; Cardiology, IRCCS MultiMedica, Sesto San Giovanni, Italy.
  • Porto I; Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy.
  • Ambrosio G; Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy.
  • Camici PG; Cardiovascular Disease Chair, Department of Internal Medicine (Di.M.I.), University of Genova, Genova, Liguria, Italy.
Heart ; 110(4): 271-280, 2024 Jan 29.
Article em En | MEDLINE | ID: mdl-37879880
OBJECTIVES: 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). METHODS: 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. RESULTS: IMR>31 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. CONCLUSIONS: 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. TRIAL REGISTRATION NUMBER: NCT04677257.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Intervenção Coronária Percutânea / Infarto do Miocárdio com Supradesnível do Segmento ST / Infarto do Miocárdio Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Intervenção Coronária Percutânea / Infarto do Miocárdio com Supradesnível do Segmento ST / Infarto do Miocárdio Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article