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Updated: Dec 31, 2025
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Invasive Evaluation of the Microvasculature in Acute Myocardial Infarction: Coronary Flow Reserve versus the Index of
John-Ross D Clarke1, Randol Kennedy2, Freddy Duarte Lau1
1Department of Internal Medicine, Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT 06610, USA.
Insights
This review highlights that microvascular obstruction (MVO) after acute myocardial infarction (AMI) significantly impacts patient outcomes. Invasive physiologic tools like coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) are crucial for evaluating the microcirculation in AMI.
Area of Science:
- Cardiology
- Cardiovascular Research
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) remains a leading cause of mortality globally.
- Despite advances in reperfusion therapy for ST-segment elevation AMI, microvascular dysfunction, including microvascular obstruction (MVO), significantly influences patient prognosis.
- Traditional angiographic methods are insufficient for assessing microcirculatory impact post-AMI.
Purpose of the Study:
- To review the role of invasive physiologic tools in evaluating the cardiac microcirculation in AMI.
- To emphasize the importance of coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in AMI management.
- To provide a comprehensive overview based on recent literature.
Main Methods:
- Systematic literature search of PubMed and Cochrane databases.
- Inclusion of English-language studies published between January 2000 and November 2019.
- Focus on studies investigating invasive physiologic assessment of the microcirculation in AMI.
Main Results:
- Invasive physiologic indices, particularly CFR and IMR, are reliable predictors of outcome in AMI.
- Microvascular obstruction (MVO) is a critical determinant of prognosis, often overlooked by traditional methods.
- Evaluation of microcirculatory function provides complementary information to epicardial reperfusion assessment.
Conclusions:
- Invasive assessment of the cardiac microcirculation is essential for comprehensive AMI evaluation.
- CFR and IMR are valuable tools for risk stratification and understanding post-AMI pathophysiology.
- Future research should further integrate microcirculatory assessment into clinical practice for improved AMI patient care.
Abstract:
Acute myocardial infarction (AMI) is one of the most common causes of death in both the developed and developing world. It has high associated morbidity despite prompt institution of recommended therapy. The focus over the last few decades in ST-segment elevation AMI has been on timely reperfusion of the epicardial vessel. However, microvascular consequences after reperfusion, such as microvascular obstruction (MVO), are equally reliable predictors of outcome. The attention on the microcirculation has meant that traditional angiographic/anatomic methods are insufficient. We searched PubMed and the Cochrane database for English-language studies published between January 2000 and November 2019 that investigated the use of invasive physiologic tools in AMI. Based on these results, we provide a comprehensive review regarding the role for the invasive evaluation of the microcirculation in AMI, with specific emphasis on coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR).
