Key result
Age and symptom-onset-to-balloon time were independent predictors of high microcirculatory resistance (microvascular dysfunction) in STEMI patients undergoing primary PCI.
Cohort (n=113)
No
Odds Ratio: 1.007 (95% CI 1.001–1.014)
p-value: p=0.018
Age and symptom-onset-to-balloon time are independent predictors of microvascular dysfunction in STEMI patients undergoing primary PCI, even when door-to-balloon time is under 90 minutes.
May flag older STEMI patients or those with delayed presentation for microvascular risk; leaves open whether interventions targeting these factors improve outcomes.
PURPOSE: We aimed to discover clinical and angiographic predictors of microvascular dysfunction using the index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS: We enrolled 113 patients with STEMI (age, 56±11 years; 95 men) who underwent primary percutaneous coronary intervention (PCI). The IMR was measured with a pressure sensor/thermistor-tipped guidewire after primary PCI. The patients were divided into three groups based on IMR values: Low IMR [<18 U (12.9±2.6 U), n=38], Mid IMR [18-31 U (23.9±4.0 U), n=38], and High IMR [>31 U (48.1±17.1 U), n=37]. RESULTS: The age of the Low IMR group was significantly lower than that of the Mid and High IMR groups. The door-to-balloon time was <90 minutes in all patients, and it was not significantly different between groups. Meanwhile, the symptom-onset-to-balloon time was significantly longer in the High IMR group, compared to the Mid and Low IMR groups (p<0.001). In the high IMR group, the culprit lesion was found in a proximal location significantly more often than in a non-proximal location (p=0.008). In multivariate regression analysis, age and symptom-onset-to-balloon time were independent determinants of a high IMR (p=0.013 and p=0.003, respectively). CONCLUSION: Our data suggest that age and symptom-onset-to-balloon time might be the major predictors of microvascular dysfunction in STEMI patients with a door-to-balloon time of <90 minutes.
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Baek et al. (2015) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=113). Symptom-onset-to-balloon time was evaluated on High Index of Microcirculatory Resistance (IMR > 31 U) (OR 1.007, 95% CI 1.001-1.014, p=0.018). Age and symptom-onset-to-balloon time were independent predictors of high microcirculatory resistance (microvascular dysfunction) in STEMI patients undergoing primary PCI.
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