Page 86 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax

Chapter 5
reference vessel CFVR at 6-month follow-up, defined as a reference vessel CFVR of ≤2.7,26,27 was associated with a 10.7-fold increase in cardiac mortality hazard during subsequent follow-up, after adjustment for the variables previously identified as associated with cardiac mortality, and including adjustment for age at the time of 6-month follow-up (HR, 10.71; 95% confidence interval, 1.45– 79.29; P=0.02).
Table 5. Left Ventricular Function and Intracoronary Hemodynamic Characteristics at 6-Month Follow- up
Reference Vessel CFVR During Index Procedure
WMSI IRA CFVR
Baseline APV, cm/s
Hyperemic APV, cm/s IRA microvascular resistance
Baseline MR, mm Hg/cm per second
Hyperemic MR, mm Hg/cm per second Reference vessel CFVR
Baseline APV, cm/s
Hyperemic APV, cm/s
Reference vessel microvascular resistance
Baseline MR, mm Hg/cm per second Hyperemic MR, mm Hg/cm per second
≥2.1 (n=53)
1.5±0.3 3.0±0.9
16±6 48±19
5.91±2.77
2.16±1.96 3.5±0.5
15±8 50±21
6.48±2.69 1.83±0.70
<2.1 (n=18)
1.8±0.3 2.3±0.7
20±7 44±19
4.52±1.42
2.03±0.77 2.8±0.5
21±9 56±17
4.42±2.10 1.55±0.59
P value
0.001
0.003
0.04 0.49
0.06
0.79 <0.001
0.01 0.29
0.007 0.16
Values are presented as frequency (%), mean±SD or median (25th-75th resistance; and WMSI, Wall Motion Score Index.
Discussion
We have previously reported that microvascular function assessed by Doppler flow velocity is altered in the setting of STEMI, even in nonischemic regions at distance from the infarcted myocardial tissue.20 This has also been observed in experimental studies, and studies using noninvasive imaging modalities.28–30 The present study is the first to indicate that this altered microvascular function at regions remote from the infarct-related artery is independently associated with long-term fatal cardiac events.
We observed that an impaired CFVR in a reference coronary artery, determined after primary PCI for a first anterior wall STEMI, is associated with a 4.09-fold
percentile). APV indicates average peak flow velocity; CFVR, coronary flow velocity reserve; IRA, infarct-related artery; MR, microvascular
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