Key result
A coronary flow reserve < 2 in the non-culprit territory independently predicted a higher risk of adverse cardiovascular events in patients with AMI (adjusted HR 6.62; 95% CI 1.30-33.70).
Why the study?
Endothelial and microvascular dysfunction frequently occur in non-culprit territories during AMI, but whether impaired non-culprit coronary physiology impacts long-term prognosis remains unclear.
Does impaired coronary physiology (specifically CFR < 2) of the non-culprit territory predict adverse cardiovascular events in patients with acute myocardial infarction?
Observational (n=84)
No
Does impaired coronary physiology (specifically CFR < 2) of the non-culprit territory predict adverse cardiovascular events in patients with acute myocardial infarction?
Hazard Ratio: 6.62 (95% CI 1.3–33.7)
In patients with acute myocardial infarction, abnormal coronary microvascular function (CFR < 2) in the non-culprit territory is a strong independent predictor of long-term adverse cardiovascular events.
May support post-AMI risk stratification by non-culprit CFR; leaves open whether it should guide therapy.
Background: Endothelial and microvascular dysfunction are frequently found in the non-culprit territory in patients with acute myocardial infarction (AMI). We aimed to determine whether an impaired coronary physiology of the non-culprit territory impacts long-term prognosis. Methods: FISIOIAM was an observational single-center study which included patients with AMI and another coronary artery lesion in a different territory. Intracoronary physiology of the non-culprit artery was analyzed early after primary percutaneous coronary intervention of the culprit artery, using fractional flow reserve (FFR), index of microcirculatory resistance (IMR), coronary flow reserve (CFR), endothelium-dependent CFR (eCFR) and macrovascular endothelial function . Patients were followed for a composite outcome of cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and hospitalization due to heart failure or unstable angina. Results: A total of 84 patients (mean age: 62 ± 10 years) were included and functional abnormalities were detected in 93% of them. During follow-up (median of 1422 days; interquartile range, 1287-1634), 13.1% of the patients experienced at least one adverse cardiovascular event. Kaplan-Meier analysis revealed that patients with a CFR < 2 had a higher risk of events (Hazard Ratio, HR: 4.97, 95% Confidence Interval, CI, 1.32-18.75), whereas other parameters such as FFR, IMR, eCFR, and macrovascular endothelial function had no effect. A low CFR was an independent predictor of cardiovascular events, even after adjustment for age and traditional cardiovascular risk factors (adjusted HR: 6.62, 95% CI, 1.30-33.70). Conclusions: The presence of abnormal coronary microvascular function as measured by a CFR < 2 in the non-culprit territory predicts future risk of adverse cardiovascular events.
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Flores et al. (2022) conducted an observational in Acute myocardial infarction (AMI) (n=84). Coronary flow reserve (CFR) < 2 in the non-culprit territory vs. CFR ≥ 2 was evaluated on Composite outcome of cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and hospitalization due to heart failure or unstable angina (adjusted HR 6.62, 95% CI 1.30-33.70). A coronary flow reserve < 2 in the non-culprit territory independently predicted a higher risk of adverse cardiovascular events in patients with AMI (adjusted HR 6.62; 95% CI 1.30-33.70).
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