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How does coronary stent implantation impact on the status of the microcirculation during primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction?

De Maria GL, Cuculi F, Patel N, Dawkins S, Fahrni G, Kassimis G, Choudhury RP, Forfar JC, Prendergast BD, Channon KM, Kharbanda RK, Banning AP - Eur. Heart J. (2015)

Bottom Line: In 15 of these patients (17.6% of the cohort), only a partial reduction in IMR occurred and these patients were more likely to be late presenters (pain to wire time >6 h).The extent of jeopardized myocardium [standardized beta: -0.26 (IMR unit/Bypass Angioplasty Revascularization Investigation score unit), P: 0.009] and pre-stenting IMR [standardized beta: -0.34 (IMR unit), P: 0.001] predicted a reduction in IMR after stenting (ΔIMR = post-stenting IMR - pre-stenting IMR), whereas thrombotic burden [standardized beta: 0.24 (IMR unit/thrombus score unit), P: 0.01] and deployed stent volume [standardized beta: 0.26 (IMR unit/mm(3) of stent), P: 0.01] were associated with a potentially deleterious increase in IMR.The causes of impaired microvascular function at the completion of PPCI treatment are heterogeneous, but can reflect a later clinical presentation and/or the location and extent of the thrombotic burden.

View Article: PubMed Central - PubMed

Affiliation: Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford OX39DU, UK.

No MeSH data available.


Related in: MedlinePlus

Evolution of coronary physiology indices after stenting in the whole patient cohort. Stenting in primary percutaneous coronary intervention is associated with an improvement in all indices of coronary physiology, both those strictly associated with the presence of the pre-procedural epicardial stenosis [mean distal pressure (Pd, A) and fractional flow reserve (FFR, C)], and those reflecting microvascular status [mean transit time (mTt, B), coronary flow reserve (CFR, D), and index of microcirculatory resistance measured and corrected (IMR and IMRcorrected, E and F)].
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EHV353F2: Evolution of coronary physiology indices after stenting in the whole patient cohort. Stenting in primary percutaneous coronary intervention is associated with an improvement in all indices of coronary physiology, both those strictly associated with the presence of the pre-procedural epicardial stenosis [mean distal pressure (Pd, A) and fractional flow reserve (FFR, C)], and those reflecting microvascular status [mean transit time (mTt, B), coronary flow reserve (CFR, D), and index of microcirculatory resistance measured and corrected (IMR and IMRcorrected, E and F)].

Mentions: In the whole cohort of 85 patients, stenting was associated with an overall improvement of all the measured indices of coronary physiology (Figure 2). Mean Pd at hyperaemia was significantly improved after stenting from 58.0 (48.0–73.0) to 75.0 (64.0–86.0) mmHg, P < 0.001 (Figure 2A), and similarly hyperaemic mTt was reduced from 0.86 (0.49–1.38) to 0.43 (0.24–0.67) s (P < 0.001; Figure 2B). As expected, both FFR [from 0.74 (0.61–0.88) to 0.94 (0.90–0.98), P < 0.001] and CFR [from 1.20 (0.96–1.62) to 1.35 (1.10–2.00), P < 0.001] improved after stenting (Figure 2C and D). Interestingly, a significant IMR reduction [from 49.7 (29.4–78.4) to 29.2 (18.9–54.3), P < 0.001] was observed after stenting (Figure 2E), and this significant trend was confirmed also in IMRcorrected [from 41.7 (25.0–67.4) to 27.9 (18.3–50.9), P: 0.01] in the subgroup of 69 patients with coronary Pw measurement (Figure 2F).Figure 2


How does coronary stent implantation impact on the status of the microcirculation during primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction?

De Maria GL, Cuculi F, Patel N, Dawkins S, Fahrni G, Kassimis G, Choudhury RP, Forfar JC, Prendergast BD, Channon KM, Kharbanda RK, Banning AP - Eur. Heart J. (2015)

Evolution of coronary physiology indices after stenting in the whole patient cohort. Stenting in primary percutaneous coronary intervention is associated with an improvement in all indices of coronary physiology, both those strictly associated with the presence of the pre-procedural epicardial stenosis [mean distal pressure (Pd, A) and fractional flow reserve (FFR, C)], and those reflecting microvascular status [mean transit time (mTt, B), coronary flow reserve (CFR, D), and index of microcirculatory resistance measured and corrected (IMR and IMRcorrected, E and F)].
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664836&req=5

EHV353F2: Evolution of coronary physiology indices after stenting in the whole patient cohort. Stenting in primary percutaneous coronary intervention is associated with an improvement in all indices of coronary physiology, both those strictly associated with the presence of the pre-procedural epicardial stenosis [mean distal pressure (Pd, A) and fractional flow reserve (FFR, C)], and those reflecting microvascular status [mean transit time (mTt, B), coronary flow reserve (CFR, D), and index of microcirculatory resistance measured and corrected (IMR and IMRcorrected, E and F)].
Mentions: In the whole cohort of 85 patients, stenting was associated with an overall improvement of all the measured indices of coronary physiology (Figure 2). Mean Pd at hyperaemia was significantly improved after stenting from 58.0 (48.0–73.0) to 75.0 (64.0–86.0) mmHg, P < 0.001 (Figure 2A), and similarly hyperaemic mTt was reduced from 0.86 (0.49–1.38) to 0.43 (0.24–0.67) s (P < 0.001; Figure 2B). As expected, both FFR [from 0.74 (0.61–0.88) to 0.94 (0.90–0.98), P < 0.001] and CFR [from 1.20 (0.96–1.62) to 1.35 (1.10–2.00), P < 0.001] improved after stenting (Figure 2C and D). Interestingly, a significant IMR reduction [from 49.7 (29.4–78.4) to 29.2 (18.9–54.3), P < 0.001] was observed after stenting (Figure 2E), and this significant trend was confirmed also in IMRcorrected [from 41.7 (25.0–67.4) to 27.9 (18.3–50.9), P: 0.01] in the subgroup of 69 patients with coronary Pw measurement (Figure 2F).Figure 2

Bottom Line: In 15 of these patients (17.6% of the cohort), only a partial reduction in IMR occurred and these patients were more likely to be late presenters (pain to wire time >6 h).The extent of jeopardized myocardium [standardized beta: -0.26 (IMR unit/Bypass Angioplasty Revascularization Investigation score unit), P: 0.009] and pre-stenting IMR [standardized beta: -0.34 (IMR unit), P: 0.001] predicted a reduction in IMR after stenting (ΔIMR = post-stenting IMR - pre-stenting IMR), whereas thrombotic burden [standardized beta: 0.24 (IMR unit/thrombus score unit), P: 0.01] and deployed stent volume [standardized beta: 0.26 (IMR unit/mm(3) of stent), P: 0.01] were associated with a potentially deleterious increase in IMR.The causes of impaired microvascular function at the completion of PPCI treatment are heterogeneous, but can reflect a later clinical presentation and/or the location and extent of the thrombotic burden.

View Article: PubMed Central - PubMed

Affiliation: Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford OX39DU, UK.

No MeSH data available.


Related in: MedlinePlus