Related Experiment Video
Updated: May 10, 2026
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Impact of coronary microvascular function on long-term cardiac mortality in patients with acute ST-segment-elevation
Tim P van de Hoef1, Matthijs Bax, Martijn Meuwissen
1Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Microvascular dysfunction in coronary arteries after ST-elevation myocardial infarction indicates higher long-term cardiac mortality risk. Assessing coronary flow velocity reserve (CFVR) post-intervention is crucial for predicting patient outcomes.
Area of Science:
- Cardiology
- Vascular Biology
- Interventional Cardiology
Background:
- Microvascular function is a key risk marker in coronary artery disease.
- Intracoronary Doppler flow velocity measurements accurately assess microvascular function.
- Limited data exist on the long-term prognostic value of microvascular function in ST-segment-elevation myocardial infarction (STEMI).
Purpose of the Study:
- To determine the prognostic value of microvascular function for cardiac mortality in STEMI patients.
- To assess microvascular function using Doppler flow velocity measurements post-primary percutaneous coronary intervention (PCI).
- To evaluate the impact of microvascular function in both infarct-related and reference coronary arteries on long-term clinical outcomes.
Main Methods:
- 100 consecutive STEMI patients undergoing primary PCI were included.
- Intracoronary Doppler flow velocity was measured post-PCI in infarct-related and reference arteries.
- Coronary flow velocity reserve (CFVR), diastolic deceleration time, and systolic retrograde flow were assessed.
- The primary endpoint was cardiac mortality at 10-year follow-up.
Main Results:
- 14% of patients experienced cardiac mortality at 10-year follow-up.
- Cardiac mortality was 5% with normal reference vessel CFVR (≥2.1) versus 31% with abnormal CFVR (<2.1).
- Abnormal reference vessel CFVR (<2.1) independently predicted a 4.09-fold increase in long-term cardiac mortality hazard (HR, 4.09; P=0.03).
Conclusions:
- Microvascular dysfunction, indicated by abnormal reference vessel CFVR after primary PCI in STEMI, significantly increases long-term cardiac mortality risk.
- Reference vessel CFVR is a valuable prognostic marker for long-term outcomes in STEMI patients.
- Doppler-derived microvascular assessment provides critical prognostic information in acute myocardial infarction management.
Background:
Microvascular function is increasingly being recognized as an important marker of risk in coronary artery disease, and may be accurately assessed by intracoronary Doppler flow velocity measurements. In the setting of ST-segment-elevation myocardial infarction there are limited data regarding the prognostic value of microvascular function in both infarct-related and reference coronary arteries for long-term clinical outcome. We sought to determine the prognostic value of microvascular function, as assessed by Doppler flow velocity measurements, for cardiac mortality after primary percutaneous coronary intervention for acute ST-segment-elevation myocardial infarction.
Methods And Results:
Between April 1997 and August 2000, we included 100 consecutive patients with a first anterior wall ST-segment-elevation myocardial infarction. Immediately after primary percutaneous coronary intervention, intracoronary Doppler flow velocity was measured in the infarct-related artery, to determine coronary flow velocity reserve (CFVR), diastolic deceleration time, and the presence of systolic retrograde flow, as well as in a reference vessel to determine reference vessel CFVR. The primary end point was cardiac mortality at 10-year follow-up. Complete follow-up was obtained in 94 patients (94%). At 10-year follow-up, cardiac mortality amounted to 14%. Cardiac mortality amounted to 5% when reference vessel CFVR was normal (≥2.1), in contrast to 31% when abnormal (<2.1; P=0.001). Reference vessel CFVR <2.1 was associated with a 4.09 increase in long-term cardiac mortality hazard after multivariate adjustment for identified predictors for cardiac mortality (hazard ratio, 4.09; 95% confidence interval, 1.18-14.17; P=0.03) CONCLUSIONS: Microvascular dysfunction, measured by reference vessel CFVR determined after primary percutaneous coronary intervention for acute anterior wall ST-segment-elevation myocardial infarction is associated with a significantly increased long-term cardiac mortality.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:21Myocarditis I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:26Coronary Artery Disease II: Pathophysiology