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Functional disorders in non-culprit coronary arteries and their implications in patients with acute myocardial

Felipe Díez-Delhoyo1, Enrique Gutiérrez-Ibañes2, Francisco Fernández-Avilés3

  • 1Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.

Trends in Cardiovascular Medicine
|September 25, 2019
PubMed

Insights

Multivessel disease in ST-elevation myocardial infarction presents challenges due to non-culprit artery physiology. This review explores microcirculation, endothelium, revascularization strategies, and assessment indices for better patient outcomes.

Area of Science:

  • Cardiology
  • Vascular Physiology
  • Interventional Cardiology

Background:

  • Multivessel disease affects 30-50% of ST-elevation acute myocardial infarction patients.
  • Non-culprit artery plaques, though seemingly stable, frequently cause adverse cardiovascular events.
  • Microvascular and endothelial dysfunction in non-culprit arteries impact prognosis and stenosis assessment.

Purpose of the Study:

  • To review methods for studying microcirculation in non-culprit arteries.
  • To discuss the role of endothelium and microvascular function in non-culprit arteries.
  • To evaluate revascularization strategies, limitations of hyperemic indices, and potential of resting indices.

Main Methods:

  • Literature review focusing on microcirculation, endothelial function, and physiological indices.
  • Analysis of current evidence on non-culprit artery physiology and management.
  • Discussion of advanced assessment techniques and their clinical implications.

Main Results:

  • Non-culprit artery physiology is complex and impacts patient outcomes.
  • Microvascular and endothelial dysfunction are significant factors in acute myocardial infarction.
  • Current physiological indices have limitations in assessing non-culprit artery stenosis severity.

Conclusions:

  • Complete revascularization strategies should be based on proven ischemia.
  • Novel resting-indices may offer better assessment in acute settings.
  • Further research is needed to optimize management of non-culprit artery disease.

Keywords:
Endothelial dysfunctionFractional flow reserveInstantaneous free-wave ratioMicrocirculationNon-culprit arterySTEMI

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