Combination of the Thermodilution-Derived Index of Microcirculatory Resistance and Coronary Flow Reserve Is Highly Predictive of Microvascular Obstruction on Cardiac Magnetic Resonance Imaging After ST-Segment Elevation Myocardial Infarction

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• 作者：Sung Gyun Ahn ; MD ; PhD^a ; ^b ; Olivia Y. Hung ; MD ; PhD^b ; Jun-Won Lee ; MD^a ; Ji Hyun Lee ; MD^a ; Young Jin Youn ; MD^a ; Min-Soo Ahn ; MD^a ; Jang-Young Kim ; MD ; PhD^a ; Byung-Su Yoo ; MD ; PhD^a ; Seung-Hwan Lee ; MD ; PhD^a ; Junghan Yoon ; MD ; PhD^a ; Woocheol Kwon ; MD ; PhD^c ; ^{wckwon@yonsei.ac.kr" class="auth_mail" title="E-mail the corresponding author} ; Habib Samady ; MD^a ; ^{hsamady@emory.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：blood flow velocity ; cardiac magnetic resonance imaging ; coronary circulation ; myocardial infarction
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：25 April 2016
• 年：2016
• 卷：9
• 期：8
• 页码：793-801
• 全文大小：1468 K

文摘

The aim of this study was to investigate the predictive accuracy of invasive coronary microvascular indexes for identifying microvascular obstruction (MVO) on cardiac magnetic resonance imaging (CMR) in patients treated with primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).

Background

We hypothesized that a combination of the index of microcirculatory resistance (IMR) and the thermodilution-derived coronary flow reserve (CFR_thermo) will enhance the predictive accuracy of detecting MVO compared with either index alone.

Methods

The IMR and CFR_thermo were measured using a single pressure sensor/thermistor-tipped guidewire in 40 STEMI patients immediately after PCI and related to MVO assessed by CMR day 7. The primary endpoint was the predictive accuracy of the IMR for detecting MVO.

Results

Patients with an IMR >36 (upper tertile) had a higher rate of MVO compared with those with an IMR ≤36 (93% vs. 39%; p = 0.001). MVO occurred in all patients with an IMR >36 and a CFR_thermo ≤1.7 and in no patients with an IMR ≤36 and a CFR_thermo >1.7. The IMR remained an independent predictor of MVO (odds ratio: 1.212, 95% confidence interval [CI]: 1.004 to 1.464; p = 0.045) after adjustment for age, creatine kinase-myocardial band, myocardial blush grade, thrombus burden, and CFR_thermo. Both the IMR (area under the curve, 0.868, 95% CI: 0.719 to 0.956; p = 0.001) and the CFR_thermo (area under the curve, 0.706, 95% CI: 0.536 to 0.842; p = 0.03) were predictive of MVO. Combined IMR and CFR_thermo increased the area under the curve for MVO to 0.941.

Conclusions

In patients who underwent primary PCI for STEMI, an increased IMR has an independent predictive value for MVO detection, and combined high IMR and low CFR_thermo are highly predictive of MVO. These indexes could be used to further risk-stratify patients and guide regional and systemic therapies.