Key result
STEMI patients with preserved or partially impaired microcirculation (Groups 1-3) were significantly more likely to show improvement in wall motion score index at 3 months compared to those with overt microvascular dysfunction (HR 9.19).
Cohort (n=89)
No
Hazard Ratio: 9.19 (95% CI 1.25–67.57)
p-value: p=0.02
Comprehensive assessment of microcirculation using both IMR and CFR after primary PCI in STEMI patients better predicts myocardial viability and long-term prognosis than either parameter alone.
Post-PCI microcirculation assessment was associated with wall motion recovery in STEMI; leaves open its role in viability prediction or management.
OBJECTIVES: A pathophysiological mechanism of microvascular dysfunction in ST-segment elevation myocardial infarction (STEMI) is multifactorial; thus, multiple modalities were needed to precisely evaluate a microcirculation. METHODS: We complementarily assessed microcirculation in STEMI by the index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) immediately after a primary percutaneous intervention in 89 STEMI patients. Cardiovascular and cerebrovascular events (MACCE) including cardiovascular death, target vessel failure, heart failure, and stroke were assessed during a mean follow-up period of 3.0 years. RESULTS: The microcirculation of enrolled patients was classified into four groups using cutoff CFR and IMR values (CFR>2 and mean IMR): group-1 (n=23, CFR>2 and IMR ≤ 27); group-2 (n=31, CFR ≤ 2 and IMR ≤ 27); group-3 (n=9, CFR>2 and IMR>27); and group-4 (n=26, CFR<2 and IMR>27). On echocardiography 3 months later, improvement in the wall motion score index was shown in group-1 (P<0.01), group-2 (P<0.01), and group-3 (P=0.04), whereas group-4 did not show improvement in wall motion score index (P=0.06). During clinical follow-up, there were no MACCE in group-1 and the patients in group-2 and group-3 showed significantly lower MACCE compared with group-4 (group-1=0%, group-2, and group-3=10%, group-4=23.1%, P=0.04). CONCLUSION: Complimentary assessment of microcirculation by the IMR and CFR may be useful to evaluate myocardial viability and the long-term prognosis of STEMI patients.
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Park et al. (2015) conducted a cohort in ST-segment elevation myocardial infarction (n=89). Preserved or partially impaired microcirculation (Groups 1-3) vs. Overt microvascular dysfunction (Group 4) was evaluated on Improvement in wall motion score index (WMSI) at 3 months (HR 9.19, 95% CI 1.250-67.57, p=0.02). STEMI patients with preserved or partially impaired microcirculation (Groups 1-3) were significantly more likely to show improvement in wall motion score index at 3 months compared to those with overt microvascular dysfunction (HR 9.19).
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