TY - JOUR
T1 - Early change in invasive measures of microvascular function can predict myocardial recovery following PCI for ST-elevation myocardial infarction
AU - Cuculi, Florim
AU - Dall'Armellina, Erica
AU - Manlhiot, Cedric
AU - De Caterina, Alberto R.
AU - Colyer, Sharon
AU - Ferreira, Vanessa
AU - Morovat, Alireza
AU - Prendergast, Bernard D.
AU - Forfar, J. Colin
AU - Alp, Nicholas J.
AU - Choudhury, Robin P.
AU - Neubauer, Stefan
AU - Channon, Keith M.
AU - Banning, Adrian P.
AU - Kharbanda, Rajesh K.
N1 - Funding Information:
F.C. was supported by fellowship grants from the Swiss National Foundation and the European Association for Percutaneous Coronary Intervention (EAPCI).
Funding Information:
The Oxford National Institute for Health Research (NIHR) Biomedical Research Centre funded this study. K.C., R.C., and S.N. acknowledge support from the BHF Centre of Research Excellence, The Alberta Innovates Health Solutions (AIHS) Clinical Fellowship, and the University of Oxford Clarendon Fund Scholarship fund VMF.
PY - 2014/8/1
Y1 - 2014/8/1
N2 - 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. All rights reserved.
AB - 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. All rights reserved.
KW - Angioplasty
KW - Blood flow
KW - Magnetic resonance imaging
KW - Microcirculation
KW - Myocardial infarction
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U2 - 10.1093/eurheartj/eht434
DO - 10.1093/eurheartj/eht434
M3 - Article
C2 - 24135835
AN - SCOPUS:84905644977
SN - 0195-668X
VL - 35
SP - 1971
EP - 1980
JO - European heart journal
JF - European heart journal
IS - 29
ER -