Functional abnormalities, including microvascular and endothelial dysfunction, were present in 93% of the nonculprit artery territories in patients with STEMI and multivessel disease.
Observational (n=84)
No
What is the prevalence of microvascular and endothelial dysfunction in the nonculprit artery in patients with STEMI and multivessel disease?
Microvascular and endothelial dysfunction are highly prevalent in the nonculprit artery of STEMI patients with multivessel disease, and early physiological assessment with acetylcholine is safe.
BACKGROUND: Approximately half of the patients presenting with ST-segment-elevation myocardial infarction (STEMI) have multivessel disease. The physiology of the nonculprit artery has not been thoroughly studied to date. We sought to characterize the coronary physiology of the nonculprit artery in the early phase after STEMI and determine the real prevalence of microvascular and endothelial dysfunction. METHODS AND RESULTS: Patients with STEMI and another coronary artery lesion in a different territory were prospectively included in an observational single-center study. The protocol took place after revascularization of the culprit artery and comprised 3 phases: first, epicardial endothelial functional assessment using intracoronary acetylcholine; second, epicardial severity quantification based on fractional flow reserve, and nonendothelial microvascular function with coronary flow reserve and the index of microvascular resistance; third, endothelium-dependent microvascular function assessment based on the endothelial coronary flow reserve. Eighty-four patients were included. Mean age was 62±10 years, and 86.9% were men. Only 6 subjects had a nonpathological study: macrovascular endothelial dysfunction was present in 60% of the patients; fractional flow reserve ≤0.8, coronary flow reserve 25 were evident in 34%, 37%, and 28% of the subjects respectively; and microvascular endothelial dysfunction (endothelial coronary flow reserve <1.5) was observed in 44%. In hospital-mortality was 0%, and no major complications occurred. At 6-month follow-up, there were no events related to the nonculprit artery. CONCLUSIONS: Microvascular and endothelial dysfunction in the nonculprit artery territory in patients with STEMI are very common. In 93% of the patients, we found functional abnormalities. Acetylcholine administration in the early phase post-STEMI in patients with multivessel disease is safe.
Díez‐Delhoyo et al. (Fri,) conducted a observational in ST-segment-elevation myocardial infarction (STEMI) with multivessel disease (n=84). Nonculprit artery lesion after STEMI was evaluated on Prevalence of functional abnormalities (microvascular or endothelial dysfunction) in the nonculprit artery. Functional abnormalities, including microvascular and endothelial dysfunction, were present in 93% of the nonculprit artery territories in patients with STEMI and multivessel disease.