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[Predictive value of coronary microcirculation dysfunction after revascularization in patients with acute myocardial
Lan Wang1, Yuliang Ma1, Weimin Wang1
1Department of Cardiology, Peking University People' s Hospital, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Beijing 100044, China.
Insights
Coronary microcirculation dysfunction (CMD) affects 60% of patients after acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI). This condition significantly increases the risk of developing acute heart failure during hospitalization.
Area of Science:
- Cardiology
- Echocardiography
- Myocardial Infarction
Context:
- Coronary microcirculation dysfunction (CMD) is a significant complication following acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI).
- Myocardial contrast echocardiography (MCE) is a key imaging modality for assessing coronary microcirculation.
- Understanding CMD's incidence and clinical impact is crucial for patient management.
Purpose:
- To determine the incidence and clinical characteristics of CMD in AMI patients post-PCI using MCE.
- To evaluate the predictive value of CMD for in-hospital acute heart failure events.
- To analyze the association between CMD and adverse clinical outcomes.
Summary:
- A study of 145 AMI patients post-PCI found a 60% incidence of CMD by MCE.
- CMD patients exhibited higher peak troponin I, poorer Killip grade, worse TIMI flow, reduced LVEF, and impaired GLS.
- CMD was independently associated with a significantly higher risk of in-hospital acute left heart failure (OR=9.120).
Impact:
- The findings highlight CMD as a prevalent issue in AMI patients post-PCI.
- CMD is a strong predictor of acute left heart failure, necessitating closer monitoring and management.
- MCE proves valuable in identifying patients at risk for heart failure post-PCI.
Objective:
To study incident and clinical characteristics of the coronary microcirculation dysfunction (CMD) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) by myocardial contrast echocardiography (MCE) and to explore the predictive value of CMD for in-hospital acute heart failure event.
Methods:
One hundred and forty five patients with AMI who had received PCI and completed MCE during hospitalization in Peking University People' s Hospital from November 2015 to July 2021 were enrolled in our study. The patients were divided into CMD group and normal group according to the coronary microcirculation status detected by MCE. Clinical data and MCE data of the two groups were collected and analyzed. The acute heart failure event during hospitalization was described. A multivariate Logistic regression model was built to analyze the risk of acute heart failure in patients with CMD. A receiver operating characteristic (ROC) curve was drawn to evaluate the value of CMD in predicting acute heart failure event.
Results:
CMD detected by MCE occurred in 87 patients (60%). Compared with normal group, patients with CMD had higher troponin I (TnI) peak level [52.8 (8.1, 84.0) μg/L vs. 18.9 (5.7, 56.1) μg/L, P=0.005], poorer Killip grade on admission (P=0.030), different culprit vessel (P < 0.001) and more patients had thrombolysis in myocardial infarction (TIMI) flow pre-PCI less than grade 3 in culprit vessel (65.1% vs. 43.1%, P=0.025). Meanwhile, patients with CMD had poorer left ventricular ejection fraction (LVEF) [52% (43%, 58%) vs. 61% (54%, 66%)], poorer global longitudinal strain (GLS) [-11.2% (-8.7%, -14.0%) vs.-13.9% (-10.8%, -17.0%)] and worse wall motion score index (WMSI) (1.58±0.36 vs. 1.25± 0.24) (P all < 0.001). Acute left heart failure happened in 13.8% of the CMD patients, which were significant higher than that in the patients with normal coronary microcirculation perfusion (1.7%, P=0.013). After correcting for the culprit vessel, the TIMI flow pre-PCI in the culprit vessel and the peak TnI value, the risk of acute left heart failure in the patients with CMD was still high (OR=9.120, 95%CI: 1.152-72.192, P=0.036). The area under ROC curve (AUC) was 0.677 (95%CI: 0.551-0.804, P=0.035).
Conclusion:
The incidence of CMD detected by MCE in patients with AMI post-PCI was 60%. Patients with CMD have a higher risk of acute left heart failure during hospitalization.
