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Eur Heart J. 2014 Aug 1;35(29):1971-80. doi: 10.1093/eurheartj/eht434. Epub 2013 Oct 17.

Early change in invasive measures of microvascular function can predict myocardial recovery following PCI for ST-elevation myocardial infarction.

Author information

1
Oxford Heart Centre, The John Radcliffe Hospital, University of Oxford, Oxford University Hospitals, OX3 9DU, Oxford, UK.
2
Department of Cardiovascular Medicine, University of Oxford, Oxford University Hospitals, Oxford, UK.
3
Department of Clinical Biochemistry, University of Oxford, Oxford University Hospitals, Oxford, UK.
4
The Hospital for Sick Children, Toronto, Canada.
5
Stephenson Cardiovascular MR Centre, Libin Cardiovascular Institute of Alberta, Calgary, Canada.
6
Oxford Acute Vascular Imaging Centre, Radcliffe Department of Medicine, Oxford, UK.
7
Oxford Heart Centre, The John Radcliffe Hospital, University of Oxford, Oxford University Hospitals, OX3 9DU, Oxford, UK rajesh.kharbanda@ouh.nhs.uk.

Abstract

AIMS:

Predicting the likely success of primary PCI to salvage potential infarcted myocardium is desirable. We compared early invasive parameters of coronary microcirculation function with the levels of circulating endothelin (ET-1) and 6-month ejection fraction after STEMI.

METHODS AND RESULTS:

Forty-four STEMI patients underwent assessment of coronary flow reserve (CFR) and index of myocardial resistance (IMR) on completion of PPCI and one day later. Cardiac magnetic resonance (CMR) at 24 h and 6 months assessed ejection fraction, oedema, late gadolinium enhancement, and salvage. In patients with depressed EF, there was no difference in IMR or CFR measured immediately after PPCI compared with those with preserved EF. However, by Day 1, CFR was significantly lower in those with depressed EF [2.0(1.5-2.3) vs. 2.6(2.1-3.3), P = 0.008]. In multivariable models, higher CFR post-PPCI [EST: +8.9 (SE 3.7) per 1 CFR unit, P = 0.03] and greater increase in CFR between post-PPCI and Day 1 [EST: +8.5 (SE 3.4) per 1 CFR unit, P = 0.01] were associated with higher salvage index. Circulating endothelin levels were significantly elevated in the low EF group at both 6 and 24 h, and 24 h levels correlated with CFR.

CONCLUSION:

Changes of the coronary microcirculation in the first day after PPCI are associated with 6-month ejection fraction and myocardial salvage. Depressed CFR at 24 h is associated with CMR imaging indices of MVO and haemorrhage and elevated endothelin levels.

KEYWORDS:

Angioplasty; Blood flow; Magnetic resonance imaging; Microcirculation; Myocardial infarction

PMID:
24135835
DOI:
10.1093/eurheartj/eht434
[Indexed for MEDLINE]

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