Coronary Microcirculation Downstream Non‐Infarct‐Related Arteries in the Subacute Phase of Myocardial Infarction: Implications for Physiology‐Guided Revascularization

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Nina W. van der Hoeven¹  Niels van Royen¹  Paul Knaapen¹  Bon‐Kwon Koo²  Joo Myung Lee³  Antonio Fernández‐Ortiz⁴  Javier Escaned⁴  Pablo Salinas⁴  Hernán Mejía‐Rentería⁴  Iván J. Núñez‐Gil⁴  María Del Trigo⁴  Luis Nombela‐Franco⁴  Carlos Macaya⁴  Pilar Jiménez‐Quevedo⁴  Nieves Gonzalo⁴  Enrico Cerrato⁵ 

[1] Department of Cardiology VU University Medical Center Amsterdam The Netherlands;Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea;Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea;Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Madrid Spain;Interventional Cardiology San Luigi Gonzaga University Hospital Orbassano and Rivoli Infermi Hospital Turin Italy;

关键词: coronary flow reserve;    coronary microcirculation;    fractional flow reserve;    microcirculatory resistance;    non‐infarct‐related arteries;   

DOI  :  10.1161/JAHA.118.011534

来源: DOAJ

【 摘 要 】

Background Concerns exist about reliability of pressure‐wire‐guided coronary revascularization of non‐infarct‐related arteries (non‐IRA). We investigated whether physiological assessment of non‐IRA during the subacute phase of myocardial infarction might be flawed by microcirculatory dysfunction. Methods and Results We analyzed non‐IRA that underwent fractional flow reserve, coronary flow reserve, and the index of microcirculatory resistance assessment. Microcirculation and hyperemic response were evaluated in 49 acute myocardial infarction patients (59 non‐IRA) and compared with a matched control group of 46 stable angina (SA) patients (59 vessels). Time between acute myocardial infarction to physiological interrogation was 5.9±2.4 days. Fractional flow reserve was similar in both groups (0.79±0.11 in non‐IRA versus 0.80±0.13 in SA vessels, P=0.527). Lower coronary flow reserve values were found in non‐IRA compared with SA vessels (1.77 [1.25–2.76] versus 2.44 [1.63–4.00], P=0.018), primarily driven by an increased baseline flow in non‐IRA (rest mean transit time 0.58 [0.32–0.83] versus 0.65 s [0.39–1.20], P=0.045), whereas the hyperemic flow was similar (hyperemic mean transit time 0.26 [0.20–0.42] versus 0.26 s [0.18–0.35], P=0.873). No differences were found regarding index of microcirculatory resistance (15.6 [10.4–21.8] in non‐IRA versus 16.7 [11.6–23.6] U in SA vessels, P=0.559). During adenosine infusion, the hyperemic response was similar in both groups (non‐IRA versus SA vessels) in terms of the resistive reserve ratio (3.1±2.1 versus 3.7±2.2, P=0.118). Conclusions In the subacute phase of myocardial infarction, non‐IRA show an increased baseline flow that may cause abnormal coronary flow reserve despite preserved hyperemic flow. In non‐IRA, microcirculatory resistance and adenosine‐induced hyperemic response are similar to those found in SA patients. From a physiological perspective, these findings support the use of fractional flow reserve to interrogate non‐IRA during the subacute phase of myocardial infarction.

【 授权许可】

Unknown