Coronary Microvascular Dysfunction Assessed by Pressure Wire and CMR After STEMI Predicts Long-Term Outcomes

JACC-CARDIOVASCULAR IMAGING

卷:14

Article

Scarsini, Roberto^1,2  Shanmuganathan, Mayooran^1,3  De Maria, Giovanni Luigi¹  Borlotti, Alessandra⁴  Kotronias, Rafail A.^1,5  Burrage, Matthew K.³  Terentes-Printzios, Dimitrios¹  Langrish, Jeremy¹  Lucking, Andrew¹  Fahrni, Gregor¹  Cuculi, Florim¹  Ribichini, Flavio²  Choudhury, Robin P.^1,4  Kharbanda, Rajesh^1,5  Ferreira, Vanessa M.^1,3  Channon, Keith M.^1,5  Banning, Adrian P.^1,5 

[1] Oxford Univ Hosp, NIHR Oxford Biomed Res Ctr, Oxford Heart Ctr, Oxford, England

[2] Univ Verona, Dept Med, Div Cardiol, Verona, Italy

[3] Univ Oxford, Radcliffe Dept Med, Oxford Ctr Clin Magnet Resonance Res, Div Cardiovasc Med, Oxford, England

[4] Univ Oxford, Radcliffe Dept Med, Acute Vasc Imaging Ctr, Oxford, England

[5] Univ Oxford, British Heart Fdn Ctr Res Excellence, Div Cardiovasc Med, Oxford, England

关键词: cardiovascular magnetic;    resonance;    coronary microvascular dysfunction;    heart failure;    index of microcirculatory resistance;    microvascular obstruction;    primary percutaneous coronary intervention;    prognosis;    ST-segment elevation myocardial infarction;   

DOI  :  10.1016/j.jcmg.2021.02.023

来源: Elsevier

【 摘 要 】

OBJECTIVES This study sought to evaluate the long-term prognostic implications of coronary microvascular dysfunction (CMD) when assessed with both cardiovascular magnetic resonance (CMR) and index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). BACKGROUND Post-ischemic CMD can be assessed using the pressure-wire based IMR and/or by the presence of microvascular obstruction (MVO) on CMR. METHODS A total of 198 patients with STEMI underwent IMR and MVO assessment. Patients were classified as follows: Group 1, no significant CMD (low IMR [#40 U] and no MVO); Group 2, CMD with either high IMR (>40 U) or MVO; Group 3, CMD with both IMR >40 U and MVO. The primary endpoint was the composite of all-cause mortality, diagnosis of new heart failure, cardiac arrest, sustained ventricular tachycardia/fibrillation, and cardioverter defibrillator implantation. RESULTS CMD with both high IMR and MVO was present in 23.7% of the cases (Group 3) and CMD with either high IMR or MVO was observed in 40.9% of cases (Group 2). At a median follow-up of 40.1 months, the primary endpoint occurred in 34 (17%) cases. At 1 year of follow-up, Group 3 (hazard ratio [HR]: 12.6; 95% confidence interval [CI]: 1.6 to 100.6; p = 0.017) but not Group 2 (HR: 7.2; 95% CI: 0.9 to 57.9; p = 0.062) had worse clinical outcomes compared with those with no significant CMD in Group 1. However, in the long-term, patients in Group 2 (HR: 4.2; 95% CI: 1.4 to 12.5; p = 0.009) and those in Group 3 (HR: 5.2; 95% CI: 1.7 to 16.2; p = 0.004) showed similar adverse outcomes, mainly driven by the occurrence of heart failure. CONCLUSIONS Post-ischemic CMD predicts a more than 4-fold increase in long-term risk of adverse outcomes, mainly driven by the occurrence of heart failure. Defining CMD by either invasive IMR >40 U or by CMR-assessed MVO showed similar risk of adverse outcomes. (J Am Coll Cardiol Img 2021;14:1948-1959) (c) 2021 by the American College of Cardiology Foundation.

【 授权许可】

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