Clinical and Angiographic Predictors of Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction.
10.3349/ymj.2015.56.5.1235
- Author:
Yong Soo BAEK
1
;
Sang Don PARK
;
Soo Han KIM
;
Man Jong LEE
;
Sung Hee SHIN
;
Dae Hyeok KIM
;
Jun KWAN
;
Keum Soo PARK
;
Seong Ill WOO
Author Information
1. Division of Cardiology, Inha University Hospital, Incheon, Korea. siwoo@inha.ac.kr
- Publication Type:Original Article
- Keywords:
Microvascular dysfunction;
ST-segment elevation myocardial infarction;
index of microcirculatory resistance;
doorto-balloon time;
symptom-onset-to-balloon time
- MeSH:
Aged;
Angiography/*methods;
Female;
Humans;
Male;
Microcirculation;
Middle Aged;
Myocardial Infarction/physiopathology/*surgery;
Operative Time;
*Percutaneous Coronary Intervention;
Regression Analysis
- From:Yonsei Medical Journal
2015;56(5):1235-1243
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: We aimed to discover clinical and angiographic predictors of microvascular dysfunction using the index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS: We enrolled 113 patients with STEMI (age, 56+/-11 years; 95 men) who underwent primary percutaneous coronary intervention (PCI). The IMR was measured with a pressure sensor/thermistor-tipped guidewire after primary PCI. The patients were divided into three groups based on IMR values: Low IMR [<18 U (12.9+/-2.6 U), n=38], Mid IMR [18-31 U (23.9+/-4.0 U), n=38], and High IMR [>31 U (48.1+/-17.1 U), n=37]. RESULTS: The age of the Low IMR group was significantly lower than that of the Mid and High IMR groups. The door-to-balloon time was <90 minutes in all patients, and it was not significantly different between groups. Meanwhile, the symptom-onset-to-balloon time was significantly longer in the High IMR group, compared to the Mid and Low IMR groups (p<0.001). In the high IMR group, the culprit lesion was found in a proximal location significantly more often than in a non-proximal location (p=0.008). In multivariate regression analysis, age and symptom-onset-to-balloon time were independent determinants of a high IMR (p=0.013 and p=0.003, respectively). CONCLUSION: Our data suggest that age and symptom-onset-to-balloon time might be the major predictors of microvascular dysfunction in STEMI patients with a door-to-balloon time of <90 minutes.
