In patients with acute myocardial infarction, a higher pressure-derived collateral flow index was associated with microvascular no-reflow (0.34 vs 0.23, p<0.01) and poorer functional recovery.
Observational (n=48)
Does pressure-derived collateral flow index (CFIp) correlate with microvascular dysfunction and functional recovery in patients with acute myocardial infarction?
In acute myocardial infarction, a higher pressure-derived collateral flow index reflects greater microvascular dysfunction and is associated with poorer functional recovery.
Tasa de eventos absoluta: 0.34% vs 0.23%
valor p: p=<0.01
OBJECTIVES: The goal of this study was to examine the implications of the pressure-derived collateral flow index (CFIp) in acute myocardial infarction (AMI). BACKGROUND: Higher CFIp is associated with less severe myocardial ischemia during angioplasty in the non-infarcted heart. It remains unknown whether CFIp also identifies collateral function in AMI patients with and without no-reflow phenomenon. METHODS: The study population included 48 patients with a first AMI. After successful percutaneous transluminal coronary angioplasty (PTCA) stent, we measured mean aortic pressure (Pa), central venous pressure (Pv) and coronary wedge pressure (Pcw) of the infarct-related artery to calculate: CFIp = (Pcw - Pv)/(Pa - Pv). Myocardial contrast echocardiography (MCE) was performed with the intracoronary injection of microbubbles to assess myocardial perfusion. Left ventriculograms at days 1 and 28 were provided for the measurement of the regional wall motion (RWM, SD/chord). RESULTS: There was no difference in CFIp among subsets based on angiographic collateral grades (grade 0, 1, 2, 3; 0.28 +/- 0.07, 0.27 +/- 0.09, 0.27 +/- 0.08, 0.23 +/- 0.08, p = NS). The CFIp was significantly higher in patients with MCE no-reflow (n = 16) than in those with MCE reflow (n = 32) (0.34 +/- 0.07 vs. 0.23 +/- 0.06, p < 0.01). There was a significant inverse correlation between the extent of functional improvement (DeltaRWM28 d-1 d) and CFIp (r = 0.56, p < 0.01), implying that higher CFIp is associated with worse functional improvement. CONCLUSIONS: In AMI, CFIp is unlikely to reflect collateral function but seems to increase with the severity of microvascular dysfunction. Because higher CFIp was associated with poorer functional recovery, it provides a simple and useful estimate of clinical outcomes in AMI.
Yamamoto et al. (Thu,) conducted a observational in Acute myocardial infarction (n=48). Pressure-derived collateral flow index (CFIp) vs. MCE reflow was evaluated on Pressure-derived collateral flow index (CFIp) in patients with MCE no-reflow versus MCE reflow (p=<0.01). In patients with acute myocardial infarction, a higher pressure-derived collateral flow index was associated with microvascular no-reflow (0.34 vs 0.23, p<0.01) and poorer functional recovery.