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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 indices of coronary physiology after stenting according to the pre-procedural microvasculature status, expressed by pre-stenting index of microcirculatory resistance. Evolution of indices of coronary physiology is influenced by the status of the coronary microvasculature before stenting. While indices mainly affected by the presence of epicardial stenosis [mean distal pressure (Pd, A) and fractional flow reserve (FFR, C)] improve irrespectively of pre-stenting index of microcirculatory resistance, a significant improvement in mean transit time (mTt, B), coronary flow reserve (CFR, D), and index of microcirculatory resistance measured and corrected (IMR and IMRcorrected, E and F) is observed after stenting only in patients with pre-stenting IMR >40.
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EHV353F3: Evolution of indices of coronary physiology after stenting according to the pre-procedural microvasculature status, expressed by pre-stenting index of microcirculatory resistance. Evolution of indices of coronary physiology is influenced by the status of the coronary microvasculature before stenting. While indices mainly affected by the presence of epicardial stenosis [mean distal pressure (Pd, A) and fractional flow reserve (FFR, C)] improve irrespectively of pre-stenting index of microcirculatory resistance, a significant improvement in mean transit time (mTt, B), coronary flow reserve (CFR, D), and index of microcirculatory resistance measured and corrected (IMR and IMRcorrected, E and F) is observed after stenting only in patients with pre-stenting IMR >40.

Mentions: The change in coronary physiology indices between patients with pre-stenting IMR ≤40 and >40 was compared. A significant improvement in parameters directly affected by epicardial stenosis, such as hyperaemic Pd and FFR, was observed after stenting in both groups (Figure 3A and C). Conversely, a significant improvement in parameters directly reflecting microvascular function, such as hyperaemic mTt [from 1.34 (0.97–1.81) to 0.73 (0.50–1.12) s, P < 0.001], CFR [from 1.06 (0.79–1.28) to 1.35 (1.02–1.90), P < 0.001], and IMR [from 67.7 (56.2–95.8) to 36.7 (22.7–59.5), P < 0.001], was observed only in the group of patients with a pre-stenting IMR of >40, whereas no significant changes after stenting was observed in the group of patients with pre-stenting IMR ≤40 [mTt from 0.43 (0.31–0.60) to 0.28 (0.21–0.50), P: 0.21; CFR from 1.68 (1.18–2.04) to 1.40 (1.12–2.21), P: 0.68; IMR from 27.1 (19.8–35.8) to 22.7 (14.7–35.4), P: 0.67] (Figure 3B, D, and E).Figure 3


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 indices of coronary physiology after stenting according to the pre-procedural microvasculature status, expressed by pre-stenting index of microcirculatory resistance. Evolution of indices of coronary physiology is influenced by the status of the coronary microvasculature before stenting. While indices mainly affected by the presence of epicardial stenosis [mean distal pressure (Pd, A) and fractional flow reserve (FFR, C)] improve irrespectively of pre-stenting index of microcirculatory resistance, a significant improvement in mean transit time (mTt, B), coronary flow reserve (CFR, D), and index of microcirculatory resistance measured and corrected (IMR and IMRcorrected, E and F) is observed after stenting only in patients with pre-stenting IMR >40.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

EHV353F3: Evolution of indices of coronary physiology after stenting according to the pre-procedural microvasculature status, expressed by pre-stenting index of microcirculatory resistance. Evolution of indices of coronary physiology is influenced by the status of the coronary microvasculature before stenting. While indices mainly affected by the presence of epicardial stenosis [mean distal pressure (Pd, A) and fractional flow reserve (FFR, C)] improve irrespectively of pre-stenting index of microcirculatory resistance, a significant improvement in mean transit time (mTt, B), coronary flow reserve (CFR, D), and index of microcirculatory resistance measured and corrected (IMR and IMRcorrected, E and F) is observed after stenting only in patients with pre-stenting IMR >40.
Mentions: The change in coronary physiology indices between patients with pre-stenting IMR ≤40 and >40 was compared. A significant improvement in parameters directly affected by epicardial stenosis, such as hyperaemic Pd and FFR, was observed after stenting in both groups (Figure 3A and C). Conversely, a significant improvement in parameters directly reflecting microvascular function, such as hyperaemic mTt [from 1.34 (0.97–1.81) to 0.73 (0.50–1.12) s, P < 0.001], CFR [from 1.06 (0.79–1.28) to 1.35 (1.02–1.90), P < 0.001], and IMR [from 67.7 (56.2–95.8) to 36.7 (22.7–59.5), P < 0.001], was observed only in the group of patients with a pre-stenting IMR of >40, whereas no significant changes after stenting was observed in the group of patients with pre-stenting IMR ≤40 [mTt from 0.43 (0.31–0.60) to 0.28 (0.21–0.50), P: 0.21; CFR from 1.68 (1.18–2.04) to 1.40 (1.12–2.21), P: 0.68; IMR from 27.1 (19.8–35.8) to 22.7 (14.7–35.4), P: 0.67] (Figure 3B, D, and E).Figure 3

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