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Functional Coronary Angiography? Derived Index of Microcirculatory Resistance in Patients With ST-Segment Elevation Myocardial Infarction

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Abstract
OBJECTIVES The aim of this study was to evaluate the diagnostic accuracy and prognostic implications of angiographyderived
index of microcirculatory resistance (angio-IMR) in patients with ST-segment elevation myocardial infarction
(STEMI).
BACKGROUND The index of microcirculatory resistance (IMR) is a reliable invasive measure of coronary microvascular
dysfunction in patients with STEMI. A functional coronary angiography?derived method to estimate IMR is a wire- and
hyperemic agent?free alternative to IMR.
METHODS The study population consisted of 2 independent cohorts. The diagnostic cohort comprised patients with
IMR from the culprit vessel immediately after successful primary percutaneous coronary intervention (n ¼ 31). The
prognostic cohort was patients with STEMI who were successfully treated with primary percutaneous coronary intervention
and followed for 10 years from the index procedure (n ¼ 309). Angio-IMR was calculated using computational
flow and pressure simulation. The primary outcome was a composite of cardiac death and readmission for heart failure
over 10 years of follow-up.
RESULTS In the diagnostic cohort, angio-IMR correlated well with IMR (R ¼ 0.778; P < 0.001). Sensitivity, specificity,
accuracy, and area under the curve of angio-IMR to predict IMR >40 U were 75.0%, 84.2%, 80.6%, and 0.899 (95%
confidence interval: 0.786-0.949), respectively. In the prognostic cohort, patients with angio-IMR >40 U showed
significantly higher risk for cardiac death or readmission for heart failure than did those with angio-IMR #40 U (46.7% vs
16.6%; adjusted hazard ratio: 2.909; 95% CI: 1.670-5.067; P < 0.001). Angio-IMR >40 U was an independent predictor
of cardiac death or readmission for heart failure (hazard ratio: 2.173; 95% CI: 1.157-4.079; P ¼ 0.016) and showed incremental
prognostic value compared with a model with clinical risk factors only (C index ¼ 0.726 vs 0.666 [P < 0.001],
net reclassification index ¼ 0.704 [P < 0.001]).
CONCLUSIONS Angio-IMR showed high correlation and diagnostic accuracy to predict IMR. Patients with STEMI with
angio-IMR >40 U showed a significantly higher risk for cardiac death or readmission for heart failure than those with
preserved angio-IMR values. (Prognostic Implication of Angiography-Derived IMR in STEMI Patients; NCT04628377)
(J Am Coll Cardiol Intv 2021;14:1670?84) ⓒ 2021 by the American College of Cardiology Foundation.
Author(s)
권현철김성목김현국도준형박태규송영빈신두섭신은석양정훈이승헌이주명장미자전기현조현성최기홍최승혁하상진한주용Neng DaiYinLiang Li
Issued Date
2021
Type
Article
Keyword
coronary microcirculationfunctional angiographyindex of microcirculatory resistancemyocardial infarctionprognosis
DOI
10.1016/j.jcin.2021.05.027
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7077
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2559429202&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Functional%20Coronary%20Angiography%3F%20Derived%20Index%20of%20Microcirculatory%20Resistance%20in%20Patients%20With%20ST-Segment%20Elevation%20Myocardial%20Infarction&amp;offset=0&amp;pcAvailability=true
Publisher
JACC-Cardiovascular Interventions
Location
미국
Language
한국어
ISSN
1936-8798
Citation Volume
14
Citation Number
15
Citation Start Page
1670
Citation End Page
1684
Appears in Collections:
Medicine > Medicine
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