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Clinical and Angiographic Predictors of Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction.

Baek YS, Park SD, Kim SH, Lee MJ, Shin SH, Kim DH, Kwan J, Park KS, Woo SI - Yonsei Med. J. (2015)

Bottom Line: The age of the Low IMR group was significantly lower than that of the Mid and High IMR groups.Meanwhile, the symptom-onset-to-balloon time was significantly longer in the High IMR group, compared to the Mid and Low IMR groups (p<0.001).In the high IMR group, the culprit lesion was found in a proximal location significantly more often than in a non-proximal location (p=0.008).

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Inha University Hospital, Incheon, Korea.

ABSTRACT

Purpose: We aimed to discover clinical and angiographic predictors of microvascular dysfunction using the index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI).

Materials and methods: We enrolled 113 patients with STEMI (age, 56±11 years; 95 men) who underwent primary percutaneous coronary intervention (PCI). The IMR was measured with a pressure sensor/thermistor-tipped guidewire after primary PCI. The patients were divided into three groups based on IMR values: Low IMR [<18 U (12.9±2.6 U), n=38], Mid IMR [18-31 U (23.9±4.0 U), n=38], and High IMR [>31 U (48.1±17.1 U), n=37].

Results: The age of the Low IMR group was significantly lower than that of the Mid and High IMR groups. The door-to-balloon time was <90 minutes in all patients, and it was not significantly different between groups. Meanwhile, the symptom-onset-to-balloon time was significantly longer in the High IMR group, compared to the Mid and Low IMR groups (p<0.001). In the high IMR group, the culprit lesion was found in a proximal location significantly more often than in a non-proximal location (p=0.008). In multivariate regression analysis, age and symptom-onset-to-balloon time were independent determinants of a high IMR (p=0.013 and p=0.003, respectively).

Conclusion: Our data suggest that age and symptom-onset-to-balloon time might be the major predictors of microvascular dysfunction in STEMI patients with a door-to-balloon time of <90 minutes.

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Related in: MedlinePlus

Comparison of IMR according to clinical and angiographic factors. *The IMR of patients with symptom-onset-to-balloon time of >180 minutes was significantly higher than the IMR of those with a symptom-onset-to-balloon ≤180 minutes, †The IMR was significantly higher in proximal lesion than in non-proximal lesion, ‡The IMR was significantly higher in initial TIMI 0/1 group, as compared initial TIMI 2/3. IMR, index of microcirculatory resistance; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery; P, proximal location of culprit artery; NP, non-proximal location of culprit artery; TIMI, thrombolysis in myocardial infarction.
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Figure 2: Comparison of IMR according to clinical and angiographic factors. *The IMR of patients with symptom-onset-to-balloon time of >180 minutes was significantly higher than the IMR of those with a symptom-onset-to-balloon ≤180 minutes, †The IMR was significantly higher in proximal lesion than in non-proximal lesion, ‡The IMR was significantly higher in initial TIMI 0/1 group, as compared initial TIMI 2/3. IMR, index of microcirculatory resistance; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery; P, proximal location of culprit artery; NP, non-proximal location of culprit artery; TIMI, thrombolysis in myocardial infarction.

Mentions: To determine whether certain parameters could influence microvascular dysfunction, we compared the IMR groups according to the presence or criteria of various parameters. As shown in Fig. 2, there were no significant differences in IMR regardless of major cardiovascular risk factors. However, our data did not show significant differences in IMR according to culprit arteries, the IMR values were significantly higher in proximal locations of the culprit lesion, as compared with non-proximal lesion (31.8±19.1 U vs. 24.6±15.8 U, p=0.033) and initial TIMI 0/1, as compared with initial TIMI 2/3 (23.0±12.8 U vs. 20.6±11.5 U, p=0.031) (Fig. 2). Since the door-to-balloon times were <90 minutes for all patients, we divided the patients into two groups (>60 minutes and ≤60 minutes). The two groups did not show a significant difference in IMR values (Fig. 2). Thereafter, the patients were divided according to a symptom-onset-to-balloon time of 180 minutes, and we observed that the IMR of those with a symptom-onset-to-balloon time of >180 minutes was significantly higher than the IMR of those with a symptom-onset-to-balloon time of ≤180 minutes (Fig. 2).


Clinical and Angiographic Predictors of Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction.

Baek YS, Park SD, Kim SH, Lee MJ, Shin SH, Kim DH, Kwan J, Park KS, Woo SI - Yonsei Med. J. (2015)

Comparison of IMR according to clinical and angiographic factors. *The IMR of patients with symptom-onset-to-balloon time of >180 minutes was significantly higher than the IMR of those with a symptom-onset-to-balloon ≤180 minutes, †The IMR was significantly higher in proximal lesion than in non-proximal lesion, ‡The IMR was significantly higher in initial TIMI 0/1 group, as compared initial TIMI 2/3. IMR, index of microcirculatory resistance; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery; P, proximal location of culprit artery; NP, non-proximal location of culprit artery; TIMI, thrombolysis in myocardial infarction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541652&req=5

Figure 2: Comparison of IMR according to clinical and angiographic factors. *The IMR of patients with symptom-onset-to-balloon time of >180 minutes was significantly higher than the IMR of those with a symptom-onset-to-balloon ≤180 minutes, †The IMR was significantly higher in proximal lesion than in non-proximal lesion, ‡The IMR was significantly higher in initial TIMI 0/1 group, as compared initial TIMI 2/3. IMR, index of microcirculatory resistance; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery; P, proximal location of culprit artery; NP, non-proximal location of culprit artery; TIMI, thrombolysis in myocardial infarction.
Mentions: To determine whether certain parameters could influence microvascular dysfunction, we compared the IMR groups according to the presence or criteria of various parameters. As shown in Fig. 2, there were no significant differences in IMR regardless of major cardiovascular risk factors. However, our data did not show significant differences in IMR according to culprit arteries, the IMR values were significantly higher in proximal locations of the culprit lesion, as compared with non-proximal lesion (31.8±19.1 U vs. 24.6±15.8 U, p=0.033) and initial TIMI 0/1, as compared with initial TIMI 2/3 (23.0±12.8 U vs. 20.6±11.5 U, p=0.031) (Fig. 2). Since the door-to-balloon times were <90 minutes for all patients, we divided the patients into two groups (>60 minutes and ≤60 minutes). The two groups did not show a significant difference in IMR values (Fig. 2). Thereafter, the patients were divided according to a symptom-onset-to-balloon time of 180 minutes, and we observed that the IMR of those with a symptom-onset-to-balloon time of >180 minutes was significantly higher than the IMR of those with a symptom-onset-to-balloon time of ≤180 minutes (Fig. 2).

Bottom Line: The age of the Low IMR group was significantly lower than that of the Mid and High IMR groups.Meanwhile, the symptom-onset-to-balloon time was significantly longer in the High IMR group, compared to the Mid and Low IMR groups (p<0.001).In the high IMR group, the culprit lesion was found in a proximal location significantly more often than in a non-proximal location (p=0.008).

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Inha University Hospital, Incheon, Korea.

ABSTRACT

Purpose: We aimed to discover clinical and angiographic predictors of microvascular dysfunction using the index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI).

Materials and methods: We enrolled 113 patients with STEMI (age, 56±11 years; 95 men) who underwent primary percutaneous coronary intervention (PCI). The IMR was measured with a pressure sensor/thermistor-tipped guidewire after primary PCI. The patients were divided into three groups based on IMR values: Low IMR [<18 U (12.9±2.6 U), n=38], Mid IMR [18-31 U (23.9±4.0 U), n=38], and High IMR [>31 U (48.1±17.1 U), n=37].

Results: The age of the Low IMR group was significantly lower than that of the Mid and High IMR groups. The door-to-balloon time was <90 minutes in all patients, and it was not significantly different between groups. Meanwhile, the symptom-onset-to-balloon time was significantly longer in the High IMR group, compared to the Mid and Low IMR groups (p<0.001). In the high IMR group, the culprit lesion was found in a proximal location significantly more often than in a non-proximal location (p=0.008). In multivariate regression analysis, age and symptom-onset-to-balloon time were independent determinants of a high IMR (p=0.013 and p=0.003, respectively).

Conclusion: Our data suggest that age and symptom-onset-to-balloon time might be the major predictors of microvascular dysfunction in STEMI patients with a door-to-balloon time of <90 minutes.

Show MeSH
Related in: MedlinePlus