Coronary microvascular dysfunction assessed by pressure wire and CMR after STEMI predicts long-term outcomes
<p><strong>Objectives:</strong><br /> This study sought to evaluate the long-term prognostic implications of coronary microvascular dysfunction (CMD) when assessed with both cardiovascular magnetic resonance (CMR) and index of microcirculatory resistance (IMR) in patients wit...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Other Authors: | |
| Format: | Journal article |
| Language: | English |
| Published: |
Elsevier
2021
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| _version_ | 1826307489540341760 |
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| author | Scarsini, R Shanmuganathan, M De Maria, GL Borlotti, A Kotronias, RA Burrage, MK Terentes-Printzios, D Langrish, J Lucking, A Fahrni, G Cuculi, F Ribichini, F Choudhury, R Kharbanda, R Ferreira, VM Channon, KM Banning, AP |
| author2 | OxAMI Study Investigators |
| author_facet | OxAMI Study Investigators Scarsini, R Shanmuganathan, M De Maria, GL Borlotti, A Kotronias, RA Burrage, MK Terentes-Printzios, D Langrish, J Lucking, A Fahrni, G Cuculi, F Ribichini, F Choudhury, R Kharbanda, R Ferreira, VM Channon, KM Banning, AP |
| author_sort | Scarsini, R |
| collection | OXFORD |
| description | <p><strong>Objectives:</strong><br />
This study sought to evaluate the long-term prognostic implications of coronary microvascular dysfunction (CMD) when assessed with both cardiovascular magnetic resonance (CMR) and index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).</p><br />
<p><strong>Background:</strong><br />
Post-ischemic CMD can be assessed using the pressure-wire based IMR and/or by the presence of microvascular obstruction (MVO) on CMR.</p><br />
<p><strong>Methods:</strong><br />
A total of 198 patients with STEMI underwent IMR and MVO assessment. Patients were classified as follows: Group 1, no significant CMD (low IMR [≤40 U] and no MVO); Group 2, CMD with either high IMR (>40 U) or MVO; Group 3, CMD with both IMR >40 U and MVO. The primary endpoint was the composite of all-cause mortality, diagnosis of new heart failure, cardiac arrest, sustained ventricular tachycardia/fibrillation, and cardioverter defibrillator implantation.</p><br />
<p><strong>Results:</strong><br />
CMD with both high IMR and MVO was present in 23.7% of the cases (Group 3) and CMD with either high IMR or MVO was observed in 40.9% of cases (Group 2). At a median follow-up of 40.1 months, the primary endpoint occurred in 34 (17%) cases. At 1 year of follow-up, Group 3 (hazard ratio [HR]: 12.6; 95% confidence interval [CI]: 1.6 to 100.6; p = 0.017) but not Group 2 (HR: 7.2; 95% CI: 0.9 to 57.9; p = 0.062) had worse clinical outcomes compared with those with no significant CMD in Group 1. However, in the long-term, patients in Group 2 (HR: 4.2; 95% CI: 1.4 to 12.5; p = 0.009) and those in Group 3 (HR: 5.2; 95% CI: 1.7 to 16.2; p = 0.004) showed similar adverse outcomes, mainly driven by the occurrence of heart failure.</p><br />
<p><strong>Conclusions:</strong><br />
Post-ischemic CMD predicts a more than 4-fold increase in long-term risk of adverse outcomes, mainly driven by the occurrence of heart failure. Defining CMD by either invasive IMR >40 U or by CMR-assessed MVO showed similar risk of adverse outcomes.</p> |
| first_indexed | 2024-03-07T07:03:50Z |
| format | Journal article |
| id | oxford-uuid:d890407e-7ce5-4645-926e-7adbc49ca303 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:03:50Z |
| publishDate | 2021 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:d890407e-7ce5-4645-926e-7adbc49ca3032022-04-14T07:59:01ZCoronary microvascular dysfunction assessed by pressure wire and CMR after STEMI predicts long-term outcomesJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:d890407e-7ce5-4645-926e-7adbc49ca303EnglishSymplectic ElementsElsevier2021Scarsini, RShanmuganathan, MDe Maria, GLBorlotti, AKotronias, RABurrage, MKTerentes-Printzios, DLangrish, JLucking, AFahrni, GCuculi, FRibichini, FChoudhury, RKharbanda, RFerreira, VMChannon, KMBanning, APOxAMI Study Investigators<p><strong>Objectives:</strong><br /> This study sought to evaluate the long-term prognostic implications of coronary microvascular dysfunction (CMD) when assessed with both cardiovascular magnetic resonance (CMR) and index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).</p><br /> <p><strong>Background:</strong><br /> Post-ischemic CMD can be assessed using the pressure-wire based IMR and/or by the presence of microvascular obstruction (MVO) on CMR.</p><br /> <p><strong>Methods:</strong><br /> A total of 198 patients with STEMI underwent IMR and MVO assessment. Patients were classified as follows: Group 1, no significant CMD (low IMR [≤40 U] and no MVO); Group 2, CMD with either high IMR (>40 U) or MVO; Group 3, CMD with both IMR >40 U and MVO. The primary endpoint was the composite of all-cause mortality, diagnosis of new heart failure, cardiac arrest, sustained ventricular tachycardia/fibrillation, and cardioverter defibrillator implantation.</p><br /> <p><strong>Results:</strong><br /> CMD with both high IMR and MVO was present in 23.7% of the cases (Group 3) and CMD with either high IMR or MVO was observed in 40.9% of cases (Group 2). At a median follow-up of 40.1 months, the primary endpoint occurred in 34 (17%) cases. At 1 year of follow-up, Group 3 (hazard ratio [HR]: 12.6; 95% confidence interval [CI]: 1.6 to 100.6; p = 0.017) but not Group 2 (HR: 7.2; 95% CI: 0.9 to 57.9; p = 0.062) had worse clinical outcomes compared with those with no significant CMD in Group 1. However, in the long-term, patients in Group 2 (HR: 4.2; 95% CI: 1.4 to 12.5; p = 0.009) and those in Group 3 (HR: 5.2; 95% CI: 1.7 to 16.2; p = 0.004) showed similar adverse outcomes, mainly driven by the occurrence of heart failure.</p><br /> <p><strong>Conclusions:</strong><br /> Post-ischemic CMD predicts a more than 4-fold increase in long-term risk of adverse outcomes, mainly driven by the occurrence of heart failure. Defining CMD by either invasive IMR >40 U or by CMR-assessed MVO showed similar risk of adverse outcomes.</p> |
| spellingShingle | Scarsini, R Shanmuganathan, M De Maria, GL Borlotti, A Kotronias, RA Burrage, MK Terentes-Printzios, D Langrish, J Lucking, A Fahrni, G Cuculi, F Ribichini, F Choudhury, R Kharbanda, R Ferreira, VM Channon, KM Banning, AP Coronary microvascular dysfunction assessed by pressure wire and CMR after STEMI predicts long-term outcomes |
| title | Coronary microvascular dysfunction assessed by pressure wire and CMR after STEMI predicts long-term outcomes |
| title_full | Coronary microvascular dysfunction assessed by pressure wire and CMR after STEMI predicts long-term outcomes |
| title_fullStr | Coronary microvascular dysfunction assessed by pressure wire and CMR after STEMI predicts long-term outcomes |
| title_full_unstemmed | Coronary microvascular dysfunction assessed by pressure wire and CMR after STEMI predicts long-term outcomes |
| title_short | Coronary microvascular dysfunction assessed by pressure wire and CMR after STEMI predicts long-term outcomes |
| title_sort | coronary microvascular dysfunction assessed by pressure wire and cmr after stemi predicts long term outcomes |
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