期刊
CIRCULATION-CARDIOVASCULAR INTERVENTIONS
卷 14, 期 2, 页码 -出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCINTERVENTIONS.120.009529
关键词
index of microcirculatory resistance; left ventricular end diastolic pressure; myocardial infarction; percutaneous coronary intervention; risk stratification
资金
- British Heart Foundation (BHF) [FS/16/74/32573]
- BHF [FS/16/74/32573, RE/18/6/34217]
- Efficacy and Mechanism Evaluation (EME) programme of the National Institute for Health Research (NIHR-EME) [12-170-45]
- EPSRC [EP/N014642/1] Funding Source: UKRI
- MRC [MC_PC_12037] Funding Source: UKRI
The combination of IMR and LVEDP has incremental value for risk stratification following primary percutaneous coronary intervention, and is predictive of major adverse cardiac events.
BACKGROUND: The index of microcirculatory resistance (IMR) of the infarct-related artery and left ventricular end-diastolic pressure (LVEDP) are acute, prognostic biomarkers in patients undergoing primary percutaneous coronary intervention. The clinical significance of IMR and LVEDP in combination is unknown. METHODS: IMR and LVEDP were prospectively measured in a prespecified substudy of the T-TIME clinical trial (Trial of Low Dose Adjunctive Alteplase During Primary PCI). IMR was measured using a pressure- and temperature-sensing guidewire following percutaneous coronary intervention. Prognostically established thresholds for IMR (>32) and LVEDP (>18 mm Hg) were predefined. Contrast-enhanced cardiovascular magnetic resonance imaging (1.5 Tesla) was acquired 2 to 7 days and 3 months postmyocardial infarction. The primary end point was major adverse cardiac events, defined as cardiac death/nonfatal myocardial infarction/heart failure hospitalization at 1 year. RESULTS: IMR and LVEDP were both measured in 131 patients (mean age 59 +/- 10.7 years, 103 [78.6%] male, 48 [36.6%] with anterior myocardial infarction). The median IMR was 29 (interquartile range, 17-55), the median LVEDP was 17 mm Hg (interquartile range, 12-21), and the correlation between them was not statistically significant (r=0.15; P=0.087). Fifty-three patients (40%) had low IMR (<= 32) and low LVEDP (<= 18), 18 (14%) had low IMR and high LVEDP, 31 (24%) had high IMR and low LVEDP, while 29 (22%) had high IMR and high LVEDP. Infarct size (% LV mass), LV ejection fraction, final myocardial perfusion grade <= 1, TIMI (Thrombolysis In Myocardial Infarction) flow grade <= 2, and coronary flow reserve were associated with LVEDP/IMR group, as was hospitalization for heart failure (n=18 events; P=0.045) and major adverse cardiac events (n=21 events; P=0.051). LVEDP>18 and IMR>32 combined was associated with major adverse cardiac events, independent of age, estimated glomerular filtration rate, and infarct-related artery (odds ratio, 5.80 [95% CI, 1.60-21.22] P=0.008). The net reclassification improvement for detecting major adverse cardiac events was 50.6% (95% CI, 2.7-98.2; P=0.033) when LVEDP>18 was added to IMR>32. CONCLUSIONS: IMR and LVEDP in combination have incremental value for risk stratification following primary percutaneous coronary intervention. REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02257294. GRAPHIC ABSTRACT: A graphic abstract is available for this article.
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