Physiologic Evaluation of Microvascular Damage in Culprit Vessel After Successful Primary Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction Patients.
- Author:
Il PARK
1
;
Joo Myung LEE
Author Information
- Publication Type:Case Report
- Keywords: Comprehensive physiologic assessment; Index of microcirculatory resistance; Coronary flow reserve; Fractional flow reserve; Microvascular damage; ST elevated myocardial infarction
- MeSH: Coronary Artery Disease; Coronary Vessels; Humans; Myocardial Infarction*; Percutaneous Coronary Intervention*; Stents; Suction; Thrombosis
- From:Journal of Lipid and Atherosclerosis 2017;6(1):46-52
- CountryRepublic of Korea
- Language:English
- Abstract: We investigated the importance of comprehensive physiologic assessment about culprit vessel in STEMI in estimating long-term clinical outcomes after complete revascularization. Comprehensive physiologic assessment provides additional information about microvascular function in coronary artery disease. This assessment includes three indices, fractional flow reserve (FFR), index of microcirculatory resistance (IMR) and coronary flow reserve (CFR). We have performed the comprehensive physiologic assessment in culprit vessels after successful primary PCI in STEMI patients. Both cases were thrombotic total occlusion in mid right coronary artery with inferior wall STEMI, successfully revascularized with stent implantation after thrombus suction. However, in post PCI physiologic assessment, one case showed overt microvascular damage. CFR was 1.1, and IMR was 75U, which was defined as a combined criterion of low CFR (<2.0) and high IMR (≥25U) in culprit vessel, but the other case showed 2.2 in CFR and 24U in IMR, which suggested no overt microvascular damage. Moreover, we can validate these findings by cardiac MR after primary PCI. Previous studies presented that the presence of overt microvascular damage was significantly associated with worse clinical outcome in patients with coronary artery disease. We suggest that comprehensive physiologic evaluation provides important information about the degree of microvascular damage and long-term clinical outcomes after complete revascularization in culprit vessel in STEMI.
