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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

Patterns of index of microcirculatory resistance (IMR) response to stenting in primary percutaneous coronary intervention patients. The graph shows the three possible patterns of index of microcirculatory resistance responses after stenting. Good responders presenting a final favourable IMR of ≤40, partial responders presenting a significant reduction in index of microcirculatory resistance, but incomplete since the final value will be still >40, and poor responders with a significant increase in index of microcirculatory resistance after stenting, ending with a final value of >40.
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EHV353F4: Patterns of index of microcirculatory resistance (IMR) response to stenting in primary percutaneous coronary intervention patients. The graph shows the three possible patterns of index of microcirculatory resistance responses after stenting. Good responders presenting a final favourable IMR of ≤40, partial responders presenting a significant reduction in index of microcirculatory resistance, but incomplete since the final value will be still >40, and poor responders with a significant increase in index of microcirculatory resistance after stenting, ending with a final value of >40.

Mentions: Three different patterns of IMR evolution after stenting were arbitrarily categorized (Figure 4): Good responders (n = 57 patients, 67% of the whole cohort) defined as patients with a final post-stenting IMR of ≤40 [IMR changed from 40.1 (24.5–61.6) to 22.1 (15.5–29.9), P < 0.001 Figure 4A]; partial responders (n = 15 patients, 17.6% of the whole cohort) were those with a pre-stenting IMR of >40 and a post-stenting IMR still of >40 [IMR changed from 80.6 (66.4–100.9) to 55.5 (51.4–61.2), P < 0.001; Figure 4B]; poor responders (n = 13 patients, 15.4% of the whole cohort) were patients with an increase in IMR and a final IMR of >40 after implantation of the stent [IMR changed from 45.7 (31.1–120.9) to 129.3 (90.9–231.8), P: 0.001; Figure 4C].Figure 4


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)

Patterns of index of microcirculatory resistance (IMR) response to stenting in primary percutaneous coronary intervention patients. The graph shows the three possible patterns of index of microcirculatory resistance responses after stenting. Good responders presenting a final favourable IMR of ≤40, partial responders presenting a significant reduction in index of microcirculatory resistance, but incomplete since the final value will be still >40, and poor responders with a significant increase in index of microcirculatory resistance after stenting, ending with a final value of >40.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

EHV353F4: Patterns of index of microcirculatory resistance (IMR) response to stenting in primary percutaneous coronary intervention patients. The graph shows the three possible patterns of index of microcirculatory resistance responses after stenting. Good responders presenting a final favourable IMR of ≤40, partial responders presenting a significant reduction in index of microcirculatory resistance, but incomplete since the final value will be still >40, and poor responders with a significant increase in index of microcirculatory resistance after stenting, ending with a final value of >40.
Mentions: Three different patterns of IMR evolution after stenting were arbitrarily categorized (Figure 4): Good responders (n = 57 patients, 67% of the whole cohort) defined as patients with a final post-stenting IMR of ≤40 [IMR changed from 40.1 (24.5–61.6) to 22.1 (15.5–29.9), P < 0.001 Figure 4A]; partial responders (n = 15 patients, 17.6% of the whole cohort) were those with a pre-stenting IMR of >40 and a post-stenting IMR still of >40 [IMR changed from 80.6 (66.4–100.9) to 55.5 (51.4–61.2), P < 0.001; Figure 4B]; poor responders (n = 13 patients, 15.4% of the whole cohort) were patients with an increase in IMR and a final IMR of >40 after implantation of the stent [IMR changed from 45.7 (31.1–120.9) to 129.3 (90.9–231.8), P: 0.001; Figure 4C].Figure 4

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