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Coronary microcirculation and peri-procedural myocardial injury during elective percutaneous coronary intervention

Fabio Mangiacapra1, Edoardo Bressi2, Giuseppe Di Gioia3

  • 1Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Unit of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.

International Journal of Cardiology
|January 14, 2020
PubMed

Insights

Microvascular resistance changes during percutaneous coronary intervention (PCI) correlate with myocardial injury. Elevated post-PCI index of microvascular resistance (IMR) predicts type 4a myocardial infarction in stable coronary artery disease patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Coronary microvascular dysfunction before percutaneous coronary intervention (PCI) is a known predictor of myocardial injury.
  • The impact of dynamic microcirculatory changes during PCI on myocardial injury and infarction remains unclear.
  • Investigating the role of microvascular resistance in PCI-related complications is crucial for patient outcomes.

Purpose of the Study:

  • To evaluate the association between pre- and post-PCI microvascular function, assessed by the index of microvascular resistance (IMR).
  • To determine the predictive value of IMR for PCI-related myocardial injury and type 4a myocardial infarction (MI).
  • To understand the dynamic changes in microcirculation during elective PCI in stable coronary artery disease (CAD) patients.

Main Methods:

  • Consecutive stable CAD patients undergoing elective PCI were enrolled.
  • Coronary physiological indexes, including IMR, were measured before and after PCI.
  • High sensitivity Troponin T (hs-TnT) levels were assessed up to 24 hours post-PCI; type 4a MI was defined per the fourth universal definition.

Main Results:

  • A significant correlation was observed between maximum post-PCI hs-Tn and IMR at both baseline and post-PCI.
  • Patients who developed type 4a MI exhibited significantly higher baseline and post-PCI IMR levels compared to those who did not.
  • Post-PCI IMR > 38 was strongly associated with elevated post-PCI hs-Tn levels and a higher incidence of type 4a MI.

Conclusions:

  • Dynamic changes in microvascular resistance following PCI are strongly linked to PCI-related myocardial injury.
  • Post-PCI IMR serves as a robust predictor of type 4a MI in patients with stable CAD undergoing elective PCI.
  • Monitoring microvascular function during and after PCI can help identify patients at risk for myocardial injury.
Abstract

Keywords:
Coronary artery diseaseCoronary microvascular functionMyocardial infarctionPercutaneous coronary intervention

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