Coronary Microvascular Dysfunction Assessed by Pressure Wire and CMR After STEMI Predicts Long-Term Outcomes
Roberto Scarsini, Mayooran Shanmuganathan, Giovanni Luigi De Maria, Alessandra Borlotti, Rafail A Kotronias, Matthew K Burrage, Dimitrios Terentes-Printzios, Jeremy Langrish, Andrew Lucking, Gregor Fahrni, Florim Cuculi, Flavio Ribichini, Robin P Choudhury, Rajesh Kharbanda, Vanessa M Ferreira, Keith M Channon, Adrian P Banning, OxAMI Study Investigators, Roberto Scarsini, Mayooran Shanmuganathan, Giovanni Luigi De Maria, Alessandra Borlotti, Rafail A Kotronias, Matthew K Burrage, Dimitrios Terentes-Printzios, Jeremy Langrish, Andrew Lucking, Gregor Fahrni, Florim Cuculi, Flavio Ribichini, Robin P Choudhury, Rajesh Kharbanda, Vanessa M Ferreira, Keith M Channon, Adrian P Banning, OxAMI Study Investigators
Abstract
Objectives: This study sought to evaluate the long-term prognostic implications of coronary microvascular dysfunction (CMD) when assessed with both cardiovascular magnetic resonance (CMR) and index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).
Background: Post-ischemic CMD can be assessed using the pressure-wire based IMR and/or by the presence of microvascular obstruction (MVO) on CMR.
Methods: A total of 198 patients with STEMI underwent IMR and MVO assessment. Patients were classified as follows: Group 1, no significant CMD (low IMR [≤40 U] and no MVO); Group 2, CMD with either high IMR (>40 U) or MVO; Group 3, CMD with both IMR >40 U and MVO. The primary endpoint was the composite of all-cause mortality, diagnosis of new heart failure, cardiac arrest, sustained ventricular tachycardia/fibrillation, and cardioverter defibrillator implantation.
Results: CMD with both high IMR and MVO was present in 23.7% of the cases (Group 3) and CMD with either high IMR or MVO was observed in 40.9% of cases (Group 2). At a median follow-up of 40.1 months, the primary endpoint occurred in 34 (17%) cases. At 1 year of follow-up, Group 3 (hazard ratio [HR]: 12.6; 95% confidence interval [CI]: 1.6 to 100.6; p = 0.017) but not Group 2 (HR: 7.2; 95% CI: 0.9 to 57.9; p = 0.062) had worse clinical outcomes compared with those with no significant CMD in Group 1. However, in the long-term, patients in Group 2 (HR: 4.2; 95% CI: 1.4 to 12.5; p = 0.009) and those in Group 3 (HR: 5.2; 95% CI: 1.7 to 16.2; p = 0.004) showed similar adverse outcomes, mainly driven by the occurrence of heart failure.
Conclusions: Post-ischemic CMD predicts a more than 4-fold increase in long-term risk of adverse outcomes, mainly driven by the occurrence of heart failure. Defining CMD by either invasive IMR >40 U or by CMR-assessed MVO showed similar risk of adverse outcomes.
Keywords: ST-segment elevation myocardial infarction; cardiovascular magnetic resonance; coronary microvascular dysfunction; heart failure; index of microcirculatory resistance; microvascular obstruction; primary percutaneous coronary intervention; prognosis.
Conflict of interest statement
Funding Support and Author Disclosures Supported by British Heart Foundation (grant CH/16/1/32013) BHF Centre of Research Excellence, Oxford (RG/13/1/30181), the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. Dr. Shanmuganathan was funded by the Alison Brading Memorial Scholarship in Medical Science, Lady Margaret Hall, University of Oxford. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed