Key result
Microvascular dysfunction in acute coronary syndrome was limited to the culprit vessel territory in the acute phase and relatively recovered at 6 months (P<0.01 for changes in CFR and IMR).
Why the study?
It was unclear whether microvascular dysfunction differed between culprit and non-culprit vessels in patients with ACS undergoing PCI.
Does microvascular dysfunction differ between culprit and non-culprit vessels in patients with acute coronary syndrome?
Observational (n=115)
Does microvascular dysfunction differ between culprit and non-culprit vessels in patients with acute coronary syndrome?
Microvascular dysfunction in acute coronary syndrome is confined to the culprit vessel territory during the acute phase and recovers by 6 months, without affecting non-culprit territories.
Suggests culprit-focused microvascular evaluation in ACS; leaves open whether serial CFR/IMR monitoring improves risk stratification.
Background This study investigated whether the microvascular dysfunction differed between culprit and non‐culprit vessels in patients with acute coronary syndrome who underwent percutaneous coronary intervention. Methods and Results In 115 prospectively recruited patients, after successful percutaneous coronary intervention, culprit and non‐culprit intracoronary hemodynamic measurements were performed and repeated at 6‐month follow‐up. 13 N‐ammonia positron emission tomography was performed at 6‐month follow‐up visit to determine absolute myocardial blood flow. The resistance values of each vessel were calculated using the coronary pressure data and the myocardial blood flow values obtained from 13 N‐ammonia positron emission tomography data. We compared the measurements between culprit and non‐culprit vessels and assessed changes in microvascular dysfunction during the study period. In 334 vessels (115 culprit and 219 non‐culprit), the culprit vessel group showed a lower fractional flow reserve and coronary flow reserve than the non‐culprit vessel group at baseline and 6‐month follow‐up, respectively. The value of index of microcirculatory resistance was different between the 2 groups in the baseline but not at 6‐month follow‐up. The microvascular resistance at rest and hyperemic microvascular resistance were not different between the 2 groups, but resistance to stenosis was higher in the culprit vessel group, under both resting and hyperemic status ( P =0.02 and P <0.01, respectively). In the culprit vessel analysis, the fractional flow reserve and index of microcirculatory resistance decreased whereas coronary flow reserve increased ( P <0.01 for all) at 6‐month follow‐up. However, there was no change in index of microcirculatory resistance, coronary flow reserve, and fractional flow reserve from baseline to 6‐month follow‐up in the non‐culprit vessel analysis. Conclusions The observed microvascular dysfunction in acute coronary syndrome is limited to the culprit vessel territory in the acute phase, which is relatively recovered in the chronic phase and there is no out‐of‐culprit territory involvement. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04169516.
No takes yet. Share an insight, caveat, or question.
Jo et al. (2020) conducted an observational in Acute coronary syndrome (n=115). Culprit vessel territory vs. Non-culprit vessel territory was evaluated on Microvascular dysfunction (fractional flow reserve, coronary flow reserve, and index of microcirculatory resistance) (p=<0.01). Microvascular dysfunction in acute coronary syndrome was limited to the culprit vessel territory in the acute phase and relatively recovered at 6 months (P<0.01 for changes in CFR and IMR).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: