Why the study?
Coronary physiology assessment is seldom considered in NSTEMI, and the incidence of microvascular dysfunction in the culprit artery acutely and at follow-up needed characterization.
In the acute phase of NSTEMI, reduced CFR is common but severe microcirculatory dysfunction is infrequent, with reduced CFR often driven by elevated resting flow rather than impaired hyperemic flow.
Microvascular assessment may aid NSTEMI culprit evaluation; leaves open prognostic value and management impact.
Background: The assessment of coronary physiology is seldom considered in cases of non-ST-elevation myocardial infarction (NSTEMI). This study aimed to characterize coronary physiology and determine the incidence of microvascular dysfunction in the myocardial infarction (MI) culprit coronary artery during the acute phase of NSTEMI and subsequent follow-up evaluation. Methods: This study included 30 patients hospitalized for NSTEMI. A physiological assessment of the MI culprit coronary artery was performed using fractional flow reserve, coronary flow reserve (CFR), and index of microcirculatory resistance (IMR). At a median of 7 months after MI, patients underwent repeated physiological assessment of the same coronary artery. Results: = 0.03) at the follow-up evaluation. Patients were categorized according to their CFR and IMR results. In patients with abnormal CFR (< 2.0) and normal IMR (< 25), reduced CFR is attributable to elevated resting coronary blood flow rather than diminished hyperemic flow. Conclusions: In the acute phase of NSTEMI, reduced CFR was commonly observed in the MI culprit coronary artery, whereas severe microcirculatory dysfunction was infrequent.
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Paiva et al. (2025) studied this question.
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