Early change in invasive measures of microvascular function can predict myocardial recovery following PCI for
Florim Cuculi1, Erica Dall'Armellina2, Cedric Manlhiot3
1Oxford Heart Centre, The John Radcliffe Hospital, University of Oxford, Oxford University Hospitals, OX3 9DU, Oxford, UK.
Insights
Coronary microcirculation changes within 24 hours after primary PCI predict myocardial salvage and ejection fraction. Lower coronary flow reserve (CFR) at 24 hours indicates poorer outcomes.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Interventional Cardiology
Background:
- Predicting myocardial salvage after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is crucial for patient outcomes.
- Early assessment of coronary microcirculation function and its relationship with myocardial salvage and long-term ejection fraction is needed.
Purpose of the Study:
- To compare early invasive parameters of coronary microcirculation function with endothelin levels and 6-month ejection fraction after STEMI.
- To investigate the association between coronary microcirculation changes and myocardial salvage.
Main Methods:
- Forty-four STEMI patients underwent assessment of coronary flow reserve (CFR) and index of myocardial resistance (IMR) post-primary PCI and at 24 hours.
- Cardiac magnetic resonance (CMR) imaging was used to assess ejection fraction, edema, late gadolinium enhancement, and salvage at 24 hours and 6 months.
- Circulating endothelin-1 (ET-1) levels were measured.
Main Results:
- While no immediate differences in IMR or CFR were observed, by Day 1, CFR was significantly lower in patients with depressed ejection fraction (EF).
- Higher CFR post-primary PCI and a greater increase in CFR between post-primary PCI and Day 1 were associated with a higher myocardial salvage index.
- Elevated endothelin levels were observed in the low EF group, correlating with CFR.
Conclusions:
- Changes in coronary microcirculation within the first day after primary PCI are linked to 6-month ejection fraction and myocardial salvage.
- Depressed CFR at 24 hours is associated with CMR-derived microvascular obstruction, hemorrhage, and elevated endothelin levels.
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.
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