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Microvascular dysfunction of the non-culprit circulation predicts poor prognosis in patients with ST-segment

Cristian Herrera Flores1,2, Felipe Díez-Delhoyo1,2, Ricardo Sanz-Ruiz1,2

  • 1Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red - Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain.

International Journal of Cardiology. Heart & Vasculature
|March 21, 2022
PubMed

Insights

Impaired coronary microvascular function in the non-culprit artery after acute myocardial infarction (AMI) predicts poor long-term outcomes. A low coronary flow reserve (CFR) is a key indicator of future cardiovascular events.

Area of Science:

  • Cardiology
  • Vascular Physiology
  • Interventional Cardiology

Background:

  • Endothelial and microvascular dysfunction are common in non-culprit territories of patients with acute myocardial infarction (AMI).
  • The impact of impaired coronary physiology in these territories on long-term prognosis remains unclear.

Purpose of the Study:

  • To investigate whether impaired coronary physiology in the non-culprit territory affects the long-term prognosis of patients with AMI.
  • To identify specific physiological parameters that predict adverse cardiovascular events.

Main Methods:

  • The FISIOIAM study was a single-center observational study of 84 patients with AMI.
  • Intracoronary physiology in the non-culprit artery was assessed using fractional flow reserve (FFR), index of microcirculatory resistance (IMR), coronary flow reserve (CFR), and endothelium-dependent CFR (eCFR).
  • Patients were followed for a composite endpoint including cardiovascular death, myocardial infarction, revascularization, and heart failure or unstable angina hospitalization.

Main Results:

  • Functional abnormalities were detected in 93% of patients.
  • A low coronary flow reserve (CFR < 2) was associated with a significantly higher risk of adverse cardiovascular events (Hazard Ratio: 4.97).
  • Low CFR was an independent predictor of cardiovascular events, even after adjusting for traditional risk factors (adjusted Hazard Ratio: 6.62). FFR, IMR, eCFR, and macrovascular endothelial function did not show significant predictive value.

Conclusions:

  • Abnormal coronary microvascular function, indicated by a CFR < 2 in the non-culprit territory, predicts future adverse cardiovascular events in AMI patients.
  • Coronary flow reserve is a crucial parameter for assessing long-term risk in the non-culprit territory post-AMI.
Abstract

Keywords:
AcetylcholineCardiovascular outcomesEndotheliumMicrocirculationMyocardial infarction

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