Coronary Microcirculation Downstream Non-Infarct-Related Arteries in the Subacute Phase of Myocardial Infarction: Implications for Physiology-Guided Revascularization

Hernán Mejía-Rentería, Joo Myung Lee, Nina W. van der Hoeven, Nieves Gonzalo, Pilar Jiménez-Quevedo, Luis Nombela-Franco, Iván J. Núñez-Gil, Pablo Salinas, María del Trigo, Enrico Cerrato, Niels van Royen, Paul Knaapen, Bon-Kwon Koo, Carlos Macaya, Antonio Fernández-Ortiz, Javier Escaned

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background Concerns exist about reliability of pressure-wire-guided coronary revascularization of non-infarct-related arteries (non- IRA ). We investigated whether physiological assessment of non- IRA during the subacute phase of myocardial infarction might be flawed by microcirculatory dysfunction. Methods and Results We analyzed non- IRA that underwent fractional flow reserve, coronary flow reserve, and the index of microcirculatory resistance assessment. Microcirculation and hyperemic response were evaluated in 49 acute myocardial infarction patients (59 non- IRA ) and compared with a matched control group of 46 stable angina ( SA ) patients (59 vessels). Time between acute myocardial infarction to physiological interrogation was 5.9±2.4 days. Fractional flow reserve was similar in both groups (0.79±0.11 in non- IRA versus 0.80±0.13 in SA vessels, P=0.527). Lower coronary flow reserve values were found in non- IRA compared with SA vessels (1.77 [1.25-2.76] versus 2.44 [1.63-4.00], P=0.018), primarily driven by an increased baseline flow in non- IRA (rest mean transit time 0.58 [0.32-0.83] versus 0.65 s [0.39-1.20], P=0.045), whereas the hyperemic flow was similar (hyperemic mean transit time 0.26 [0.20-0.42] versus 0.26 s [0.18-0.35], P=0.873). No differences were found regarding index of microcirculatory resistance (15.6 [10.4-21.8] in non- IRA versus 16.7 [11.6-23.6] U in SA vessels, P=0.559). During adenosine infusion, the hyperemic response was similar in both groups (non- IRA versus SA vessels) in terms of the resistive reserve ratio (3.1±2.1 versus 3.7±2.2, P=0.118). Conclusions In the subacute phase of myocardial infarction, non- IRA show an increased baseline flow that may cause abnormal coronary flow reserve despite preserved hyperemic flow. In non- IRA , microcirculatory resistance and adenosine-induced hyperemic response are similar to those found in SA patients. From a physiological perspective, these findings support the use of fractional flow reserve to interrogate non- IRA during the subacute phase of myocardial infarction.
Original languageEnglish
Pages (from-to)e011534
JournalJournal of the American Heart Association
Volume8
Issue number9
DOIs
Publication statusPublished - 2019

Cite this

Mejía-Rentería, Hernán ; Lee, Joo Myung ; van der Hoeven, Nina W. ; Gonzalo, Nieves ; Jiménez-Quevedo, Pilar ; Nombela-Franco, Luis ; Núñez-Gil, Iván J. ; Salinas, Pablo ; del Trigo, María ; Cerrato, Enrico ; van Royen, Niels ; Knaapen, Paul ; Koo, Bon-Kwon ; Macaya, Carlos ; Fernández-Ortiz, Antonio ; Escaned, Javier. / Coronary Microcirculation Downstream Non-Infarct-Related Arteries in the Subacute Phase of Myocardial Infarction: Implications for Physiology-Guided Revascularization. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 9. pp. e011534.
@article{01a981ed37114c96b9e25eb9e01ba786,
title = "Coronary Microcirculation Downstream Non-Infarct-Related Arteries in the Subacute Phase of Myocardial Infarction: Implications for Physiology-Guided Revascularization",
abstract = "Background Concerns exist about reliability of pressure-wire-guided coronary revascularization of non-infarct-related arteries (non- IRA ). We investigated whether physiological assessment of non- IRA during the subacute phase of myocardial infarction might be flawed by microcirculatory dysfunction. Methods and Results We analyzed non- IRA that underwent fractional flow reserve, coronary flow reserve, and the index of microcirculatory resistance assessment. Microcirculation and hyperemic response were evaluated in 49 acute myocardial infarction patients (59 non- IRA ) and compared with a matched control group of 46 stable angina ( SA ) patients (59 vessels). Time between acute myocardial infarction to physiological interrogation was 5.9±2.4 days. Fractional flow reserve was similar in both groups (0.79±0.11 in non- IRA versus 0.80±0.13 in SA vessels, P=0.527). Lower coronary flow reserve values were found in non- IRA compared with SA vessels (1.77 [1.25-2.76] versus 2.44 [1.63-4.00], P=0.018), primarily driven by an increased baseline flow in non- IRA (rest mean transit time 0.58 [0.32-0.83] versus 0.65 s [0.39-1.20], P=0.045), whereas the hyperemic flow was similar (hyperemic mean transit time 0.26 [0.20-0.42] versus 0.26 s [0.18-0.35], P=0.873). No differences were found regarding index of microcirculatory resistance (15.6 [10.4-21.8] in non- IRA versus 16.7 [11.6-23.6] U in SA vessels, P=0.559). During adenosine infusion, the hyperemic response was similar in both groups (non- IRA versus SA vessels) in terms of the resistive reserve ratio (3.1±2.1 versus 3.7±2.2, P=0.118). Conclusions In the subacute phase of myocardial infarction, non- IRA show an increased baseline flow that may cause abnormal coronary flow reserve despite preserved hyperemic flow. In non- IRA , microcirculatory resistance and adenosine-induced hyperemic response are similar to those found in SA patients. From a physiological perspective, these findings support the use of fractional flow reserve to interrogate non- IRA during the subacute phase of myocardial infarction.",
author = "Hern{\'a}n Mej{\'i}a-Renter{\'i}a and Lee, {Joo Myung} and {van der Hoeven}, {Nina W.} and Nieves Gonzalo and Pilar Jim{\'e}nez-Quevedo and Luis Nombela-Franco and N{\'u}{\~n}ez-Gil, {Iv{\'a}n J.} and Pablo Salinas and {del Trigo}, Mar{\'i}a and Enrico Cerrato and {van Royen}, Niels and Paul Knaapen and Bon-Kwon Koo and Carlos Macaya and Antonio Fern{\'a}ndez-Ortiz and Javier Escaned",
year = "2019",
doi = "10.1161/JAHA.118.011534",
language = "English",
volume = "8",
pages = "e011534",
journal = "Journal of American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "9",

}

Mejía-Rentería, H, Lee, JM, van der Hoeven, NW, Gonzalo, N, Jiménez-Quevedo, P, Nombela-Franco, L, Núñez-Gil, IJ, Salinas, P, del Trigo, M, Cerrato, E, van Royen, N, Knaapen, P, Koo, B-K, Macaya, C, Fernández-Ortiz, A & Escaned, J 2019, 'Coronary Microcirculation Downstream Non-Infarct-Related Arteries in the Subacute Phase of Myocardial Infarction: Implications for Physiology-Guided Revascularization' Journal of the American Heart Association, vol. 8, no. 9, pp. e011534. https://doi.org/10.1161/JAHA.118.011534

Coronary Microcirculation Downstream Non-Infarct-Related Arteries in the Subacute Phase of Myocardial Infarction: Implications for Physiology-Guided Revascularization. / Mejía-Rentería, Hernán; Lee, Joo Myung; van der Hoeven, Nina W.; Gonzalo, Nieves; Jiménez-Quevedo, Pilar; Nombela-Franco, Luis; Núñez-Gil, Iván J.; Salinas, Pablo; del Trigo, María; Cerrato, Enrico; van Royen, Niels; Knaapen, Paul; Koo, Bon-Kwon; Macaya, Carlos; Fernández-Ortiz, Antonio; Escaned, Javier.

In: Journal of the American Heart Association, Vol. 8, No. 9, 2019, p. e011534.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Coronary Microcirculation Downstream Non-Infarct-Related Arteries in the Subacute Phase of Myocardial Infarction: Implications for Physiology-Guided Revascularization

AU - Mejía-Rentería, Hernán

AU - Lee, Joo Myung

AU - van der Hoeven, Nina W.

AU - Gonzalo, Nieves

AU - Jiménez-Quevedo, Pilar

AU - Nombela-Franco, Luis

AU - Núñez-Gil, Iván J.

AU - Salinas, Pablo

AU - del Trigo, María

AU - Cerrato, Enrico

AU - van Royen, Niels

AU - Knaapen, Paul

AU - Koo, Bon-Kwon

AU - Macaya, Carlos

AU - Fernández-Ortiz, Antonio

AU - Escaned, Javier

PY - 2019

Y1 - 2019

N2 - Background Concerns exist about reliability of pressure-wire-guided coronary revascularization of non-infarct-related arteries (non- IRA ). We investigated whether physiological assessment of non- IRA during the subacute phase of myocardial infarction might be flawed by microcirculatory dysfunction. Methods and Results We analyzed non- IRA that underwent fractional flow reserve, coronary flow reserve, and the index of microcirculatory resistance assessment. Microcirculation and hyperemic response were evaluated in 49 acute myocardial infarction patients (59 non- IRA ) and compared with a matched control group of 46 stable angina ( SA ) patients (59 vessels). Time between acute myocardial infarction to physiological interrogation was 5.9±2.4 days. Fractional flow reserve was similar in both groups (0.79±0.11 in non- IRA versus 0.80±0.13 in SA vessels, P=0.527). Lower coronary flow reserve values were found in non- IRA compared with SA vessels (1.77 [1.25-2.76] versus 2.44 [1.63-4.00], P=0.018), primarily driven by an increased baseline flow in non- IRA (rest mean transit time 0.58 [0.32-0.83] versus 0.65 s [0.39-1.20], P=0.045), whereas the hyperemic flow was similar (hyperemic mean transit time 0.26 [0.20-0.42] versus 0.26 s [0.18-0.35], P=0.873). No differences were found regarding index of microcirculatory resistance (15.6 [10.4-21.8] in non- IRA versus 16.7 [11.6-23.6] U in SA vessels, P=0.559). During adenosine infusion, the hyperemic response was similar in both groups (non- IRA versus SA vessels) in terms of the resistive reserve ratio (3.1±2.1 versus 3.7±2.2, P=0.118). Conclusions In the subacute phase of myocardial infarction, non- IRA show an increased baseline flow that may cause abnormal coronary flow reserve despite preserved hyperemic flow. In non- IRA , microcirculatory resistance and adenosine-induced hyperemic response are similar to those found in SA patients. From a physiological perspective, these findings support the use of fractional flow reserve to interrogate non- IRA during the subacute phase of myocardial infarction.

AB - Background Concerns exist about reliability of pressure-wire-guided coronary revascularization of non-infarct-related arteries (non- IRA ). We investigated whether physiological assessment of non- IRA during the subacute phase of myocardial infarction might be flawed by microcirculatory dysfunction. Methods and Results We analyzed non- IRA that underwent fractional flow reserve, coronary flow reserve, and the index of microcirculatory resistance assessment. Microcirculation and hyperemic response were evaluated in 49 acute myocardial infarction patients (59 non- IRA ) and compared with a matched control group of 46 stable angina ( SA ) patients (59 vessels). Time between acute myocardial infarction to physiological interrogation was 5.9±2.4 days. Fractional flow reserve was similar in both groups (0.79±0.11 in non- IRA versus 0.80±0.13 in SA vessels, P=0.527). Lower coronary flow reserve values were found in non- IRA compared with SA vessels (1.77 [1.25-2.76] versus 2.44 [1.63-4.00], P=0.018), primarily driven by an increased baseline flow in non- IRA (rest mean transit time 0.58 [0.32-0.83] versus 0.65 s [0.39-1.20], P=0.045), whereas the hyperemic flow was similar (hyperemic mean transit time 0.26 [0.20-0.42] versus 0.26 s [0.18-0.35], P=0.873). No differences were found regarding index of microcirculatory resistance (15.6 [10.4-21.8] in non- IRA versus 16.7 [11.6-23.6] U in SA vessels, P=0.559). During adenosine infusion, the hyperemic response was similar in both groups (non- IRA versus SA vessels) in terms of the resistive reserve ratio (3.1±2.1 versus 3.7±2.2, P=0.118). Conclusions In the subacute phase of myocardial infarction, non- IRA show an increased baseline flow that may cause abnormal coronary flow reserve despite preserved hyperemic flow. In non- IRA , microcirculatory resistance and adenosine-induced hyperemic response are similar to those found in SA patients. From a physiological perspective, these findings support the use of fractional flow reserve to interrogate non- IRA during the subacute phase of myocardial infarction.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/31014181

U2 - 10.1161/JAHA.118.011534

DO - 10.1161/JAHA.118.011534

M3 - Article

VL - 8

SP - e011534

JO - Journal of American Heart Association

JF - Journal of American Heart Association

SN - 2047-9980

IS - 9

ER -