Download This Paper
Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.
Coronary Angiography-Derived Index of Microcirculatory Resistance and Evolution of Infarct Pathology after STEMI
34 Pages Posted: 9 Sep 2022
More...Abstract
Background: A new coronary angiography-derived method to estimate index of microcirculatory resistance (IMR) has been developed as a wire- and hyperemic agent-free alternative to IMR for assessment of coronary microcirculation. This study sought to evaluate the association of coronary angiography-derived index of microcirculatory resistance (angio-IMR) measured after primary percutaneous coronary intervention (PPCI) with evolution of infarct pathology during 3-month follow-up after ST-segment-elevation myocardial infarction (STEMI).
Methods: Patients with STEMI undergoing PPCI were prospectively enrolled between October 2019 and August 2021. Angio-IMR was calculated using computational flow and pressure simulation. Cardiac magnetic resonance (CMR) imaging was performed at a median of 3.6 days and 3 months.
Findings: A total of 286 STEMI patients (mean age 57·8 years, 84·3% men) with both angio-IMR and CMR at baseline were included. High angio-IMR (>40 U) occurred in 84 patients (29·4%) patients. Patients with angio-IMR >40 U had higher prevalence and extent of MVO. An angio-IMR >40 U was a multivariable predictor of infarct size with 3-fold higher risk of final infarct size >25% (adjusted OR 3·00, 95% CI 1·23-7·32, p = 0·016). Post-procedure angio-IMR >40 U significantly predicted presence (adjusted OR 5·52, 95% CI 1·65-18·51, p=0·006) and extent (beta coefficient 0·27, 95% CI 0·01-0·53, p=0·041) of myocardial iron at follow-up.
Interpretation: Angio-IMR immediately post PPCI showed a significant association with extent and evolution of infarct pathology. An angio-IMR >40 U indicated extensive microvascular damage with less regression of infarct size and more persistent iron at follow-up.
Funding Information: This study was funded by grants from Beijing Nova Program (Z201100006820087), Interdisciplinary Cooperation Project of Beijing Nova Program (Z211100002121165), Natural Science Foundation of Beijing, China (7222046, 7191002), National Key R&D Program of China (2020YFC2004800), the Capital Health Research and Development of Special Fund (2018-1-2061).
Declaration of Interests: The author declares no conflict of interest. Dr. William F. Fearon: institutional research grants from Abbott, Boston Scientific, Edwards LifeSciences and Medtronic, consulting with CathWorks and Siemens and stock options with HeartFlow. Dr. Shaoping Nie: research grants to the institution from Boston Scientific, Abbott, Jiangsu Hengrui Pharmaceuticals, China Resources Sanjiu Medical & Pharmaceuticals, East China Pharmaceuticals. The rest of the authors have no relevant relationships to disclose.
Ethics Approval Statement: The study protocol was approved by the institutional review board of Beijing Anzhen Hospital, Capital Medical University. All subjects provided written informed consent before enrollment.
Keywords: Cardiovascular magnetic resonance, Index of microcirculatory resistance, Microvascular obstruction, Myocardial infarction
Suggested Citation: Suggested Citation