Page 85 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax

Coronary microvascular function and long-term mortality
assessed after reperfusion, as well as TIMI flow grade <3 at the end of the procedure as were associated with cardiac mortality at long-term follow-up (Table 4). After adjustment for these variables, a reference vessel CFVR of <2.1 was associated with a 4.09-fold increase in long-term cardiac mortality hazard (HR, 4.09; 95% confidence interval, 1.18–14.17; P=0.03).
Table 4. Prognostic Value for Long-term Cardiac Mortality by Univariable and Multivariable Cox Proportional Hazard Analysis
Univariable Analysis
Multivariable Analysis
Variable
End Procedural RefCFVR <2.1 Age≥65 y
NT-proBNP after reperfusion (per quartile increase*)
History of hypertension
End procedural TIMI flow grade <3
Hazard 95% Ratio Confidence
Interval
4.33 1.48–12.68 3.10 1.12–8.56 2.28 1.24–4.21
P Hazard value Ratio
0.01 4.09 0.03 2.27 0.01 1.98
95% P Confidence value
Interval
1.18–14.17 0.03
0.62–8.28 0.22
1.02–3.82 0.04 5
3.29 1.14–9.49 0.03 4.09 1.48–11.30 0.01
NT-proBNP incdicates N-Type probrain natriuretic peptide; RefCFVR,
reserve; and TIMI, Thrombolysis In Myocardial Infarction.
* Quartiles represent: <47.4 ng/L, 47.4 to 87.4 ng/L, 87.5 to 207.3 ng/L, ≥207.4 ng/L.
Ventricular Function and CFVR at 6-Month Follow-up and Long-term Cardiac Mortality
Six-month follow-up WMSI and intracoronary measurements were available in 71 patients (Table 5).20 At 6-month follow-up, there was a numerically small, but statistically significant difference in left ventricular function between both reference vessel CFVR groups, as assessed by WMSI (Table 5). Importantly, WMSI at 6-month follow-up was not associated with an increase in cardiac mortality hazard at long-term follow-up (HR, 5.49; 95% confidence interval, 0.59–50.75; P=0.13). CFVR in both the target, as well as the reference vessel remained lower within those patients with low reference vessel CFVR after reperfusion during the index procedure (Table 5). Notably, in contrast with the findings directly after reperfusion, the impairment of CFVR in both infarct- related, as well as reference coronary arteries at 6-month follow-up resulted from a significantly higher baseline APV in the presence of a significantly lower baseline microvascular resistance in patients with impaired CFVR. Contrariwise, hyperemic APV, in concordance with hyperemic microvascular resistance, did not differ between groups (Table 5). A persistently impaired
reference coronary flow velocity
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