Why the study?
While IMR predicts left ventricular recovery after STEMI and caIMR is a novel alternative, the impact of caIMR on left ventricular performance recovery required investigation.
Does post-PCI caIMR predict left ventricular performance recovery at 3 months in patients with STEMI treated by primary PCI?
Does post-PCI caIMR predict left ventricular performance recovery at 3 months in patients with STEMI treated by primary PCI?
Post-PCI caIMR can accurately predict left ventricular functional recovery at 3 months follow-up in patients with STEMI treated by primary PCI.
Post-PCI caIMR was associated with LV recovery after STEMI; hypothesis-generating and requires prospective validation before clinical adoption.
Objectives. The present study is designed to investigate the impact of coronary angiography-derived index of microcirculatory resistance (caIMR) on left ventricular performance recovery. Background. IMR has been established as a gold standard for coronary microvascular assessment and a predictor of left ventricular recovery after ST-segment elevation myocardial infarction (STEMI). CaIMR is a novel and accurate alternative of IMR. Methods. The present study retrospectively included 80 patients with STEMI who underwent primary percutaneous coronary intervention (PCI). We offline performed the post-PCI caIMR analysis of the culprit vessel. Echocardiography was performed within the first 24 hours and at 3 months after the index procedure. Left ventricular recovery was defined as the change in left ventricular ejection fraction (LVEF) more than zero. Results. The mean age of the patients was 58.0 years with 80.0% male. The average post-PCI caIMR was 43.2. Overall left ventricular recovery was seen in 41 patients. Post-PCI caIMR (OR: 0.948, 95% CI: 0.916–0.981, p = 0.002), left anterior descending as the culprit vessel (OR: 3.605, 95% CI: 1.23–10.567, p = 0.019), and male (OR: 0.254, 95% CI: 0.066–0.979, p = 0.047) were independent predictors of left ventricular recovery at 3 months follow-up. A predictive model was established with the best cutoff value for the prediction of left ventricular recovery 2.33 (sensitivity 0.610, specificity 0.897, and area under the curve 0.765). In patients with a predictive model score less than 2.33, the LVEF increased significantly at 3 months. Conclusions. The post-PCI caIMR can accurately predict left ventricular functional recovery at 3 months follow-up in patients with STEMI treated by primary PCI, supporting its use in clinical practice.
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Hou et al. (2022) studied this question.
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