One-year results from the Assessing MICRO-vascular resistances
STEMI
fractional flow reserve (FFR)
microvascular resistance
multivessel disease (MVD)
índex of microvascular resistance (IMR)
Journal
Frontiers in cardiovascular medicine
ISSN: 2297-055X
Titre abrégé: Front Cardiovasc Med
Pays: Switzerland
ID NLM: 101653388
Informations de publication
Date de publication:
2022
2022
Historique:
received:
22
09
2022
accepted:
21
11
2022
entrez:
19
12
2022
pubmed:
20
12
2022
medline:
20
12
2022
Statut:
epublish
Résumé
In ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary angioplasty (PPCI) the index of microcirculatory resistance (IMR) correlates to the extent of myocardial damage and left ventricular (LV) function recovery. Data on the IMR time-course and impact on clinical outcome in STEMI patients with multi-vessel disease (MVD) are scarce. We designed a prospective, multicenter clinical trial to assess the infarct-related artery (IRA)-IMR in STEMI patients with MVD undergoing PPCI and to explore its potential in relationship with outcome and LV remodeling. The study enrolled 242 STEMI patients with MVD. Both fractional flow reserve (FFR) and IMR of the IRA were assessed after successful PPCI. Then, FFR/IMR measurements were repeated in the IRA at a staged angiography, and FFR-guided angioplasty was performed in non-IRA lesions. The primary endpoint was the composite of cardiovascular death, re-infarction, re-hospitalization for heart failure, resuscitation or appropriate ICD shock at 1-year follow-up. A significant improvement of IRA-IMR values (from 47.9 to 34.2, After successful PPCI, a significant proportion of patients with STEMI and MVD had coronary microvascular dysfunction as assessed by IMR that recovered early after reperfusion. Higher IMR values predicted lack of improvement of LV function only in anterior STEMI. https://clinicaltrials.gov/, identifier [NCT02325973].
Sections du résumé
Background
UNASSIGNED
In ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary angioplasty (PPCI) the index of microcirculatory resistance (IMR) correlates to the extent of myocardial damage and left ventricular (LV) function recovery. Data on the IMR time-course and impact on clinical outcome in STEMI patients with multi-vessel disease (MVD) are scarce.
Aims
UNASSIGNED
We designed a prospective, multicenter clinical trial to assess the infarct-related artery (IRA)-IMR in STEMI patients with MVD undergoing PPCI and to explore its potential in relationship with outcome and LV remodeling.
Methods
UNASSIGNED
The study enrolled 242 STEMI patients with MVD. Both fractional flow reserve (FFR) and IMR of the IRA were assessed after successful PPCI. Then, FFR/IMR measurements were repeated in the IRA at a staged angiography, and FFR-guided angioplasty was performed in non-IRA lesions. The primary endpoint was the composite of cardiovascular death, re-infarction, re-hospitalization for heart failure, resuscitation or appropriate ICD shock at 1-year follow-up.
Results
UNASSIGNED
A significant improvement of IRA-IMR values (from 47.9 to 34.2,
Conclusion
UNASSIGNED
After successful PPCI, a significant proportion of patients with STEMI and MVD had coronary microvascular dysfunction as assessed by IMR that recovered early after reperfusion. Higher IMR values predicted lack of improvement of LV function only in anterior STEMI.
Clinical trial registration
UNASSIGNED
https://clinicaltrials.gov/, identifier [NCT02325973].
Identifiants
pubmed: 36531736
doi: 10.3389/fcvm.2022.1051174
pmc: PMC9755670
doi:
Banques de données
ClinicalTrials.gov
['NCT02325973']
Types de publication
Journal Article
Langues
eng
Pagination
1051174Informations de copyright
Copyright © 2022 Fineschi, Verna, Barioli, Mezzapelle, Bartolini, Turiano, Guiducci, Manari, Lucarelli, Uguccioni, Repetto and Tarantini.
Déclaration de conflit d'intérêts
Authors MF, EV, and GM report speaker honoraria from St. Jude Medical Italia (now Abbott). Authors MF and EV also report consulting fees for St. Jude Medical Italia (now Abbott). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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