BACKGROUND: Most methods for assessing microvascular function are not readily available in the cardiac catheterization laboratory. The aim of this study is to determine whether the Index of Microcirculatory Resistance (IMR), measured at the time of primary percutaneous coronary intervention, is predictive of death and rehospitalization for heart failure. METHODS AND RESULTS: IMR was measured immediately after primary percutaneous coronary intervention in 253 patients from 3 institutions with the use of a pressure-temperature sensor wire. The primary end point was the rate of death or rehospitalization for heart failure. The prognostic value of IMR was compared with coronary flow reserve, TIMI myocardial perfusion grade, and clinical variables. The mean IMR was 40.3±32.5. Patients with an IMR >40 had a higher rate of the primary end point at 1 year than patients with an IMR ≤40 (17.1% versus 6.6%; P=0.027). During a median follow-up period of 2.8 years, 13.8% experienced the primary end point and 4.3% died. An IMR >40 was associated with an increased risk of death or rehospitalization for heart failure (hazard ratio [HR], 2.1; P=0.034) and of death alone (HR, 3.95; P=0.028). On multivariable analysis, independent predictors of death or rehospitalization for heart failure included IMR >40 (HR, 2.2; P=0.026), fractional flow reserve ≤0.8 (HR, 3.24; P=0.008), and diabetes mellitus (HR, 4.4; P<0.001). An IMR >40 was the only independent predictor of death alone (HR, 4.3; P=0.02). CONCLUSIONS: An elevated IMR at the time of primary percutaneous coronary intervention predicts poor long-term outcomes.
BACKGROUND: Most methods for assessing microvascular function are not readily available in the cardiac catheterization laboratory. The aim of this study is to determine whether the Index of Microcirculatory Resistance (IMR), measured at the time of primary percutaneous coronary intervention, is predictive of death and rehospitalization for heart failure. METHODS AND RESULTS: IMR was measured immediately after primary percutaneous coronary intervention in 253 patients from 3 institutions with the use of a pressure-temperature sensor wire. The primary end point was the rate of death or rehospitalization for heart failure. The prognostic value of IMR was compared with coronary flow reserve, TIMI myocardial perfusion grade, and clinical variables. The mean IMR was 40.3±32.5. Patients with an IMR >40 had a higher rate of the primary end point at 1 year than patients with an IMR ≤40 (17.1% versus 6.6%; P=0.027). During a median follow-up period of 2.8 years, 13.8% experienced the primary end point and 4.3% died. An IMR >40 was associated with an increased risk of death or rehospitalization for heart failure (hazard ratio [HR], 2.1; P=0.034) and of death alone (HR, 3.95; P=0.028). On multivariable analysis, independent predictors of death or rehospitalization for heart failure included IMR >40 (HR, 2.2; P=0.026), fractional flow reserve ≤0.8 (HR, 3.24; P=0.008), and diabetes mellitus (HR, 4.4; P<0.001). An IMR >40 was the only independent predictor of death alone (HR, 4.3; P=0.02). CONCLUSIONS: An elevated IMR at the time of primary percutaneous coronary intervention predicts poor long-term outcomes.
Authors: Nico H J Pijls; Bernard De Bruyne; Leif Smith; Wilbert Aarnoudse; Emanuele Barbato; Jozef Bartunek; G Jan Willem Bech; Frans Van De Vosse Journal: Circulation Date: 2002-05-28 Impact factor: 29.690
Authors: William F Fearon; Maulik Shah; Martin Ng; Todd Brinton; Andrew Wilson; Jennifer A Tremmel; Ingela Schnittger; David P Lee; Randall H Vagelos; Peter J Fitzgerald; Paul G Yock; Alan C Yeung Journal: J Am Coll Cardiol Date: 2008-02-05 Impact factor: 24.094
Authors: C M Gibson; C P Cannon; W L Daley; J T Dodge; B Alexander; S J Marble; C H McCabe; L Raymond; T Fortin; W K Poole; E Braunwald Journal: Circulation Date: 1996-03-01 Impact factor: 29.690
Authors: Felipe Díez-Delhoyo; Enrique Gutiérrez-Ibañes; Gerard Loughlin; Ricardo Sanz-Ruiz; María Eugenia Vázquez-Álvarez; Fernando Sarnago-Cebada; Rocío Angulo-Llanos; Ana Casado-Plasencia; Jaime Elízaga; Francisco Fernández Avilés Diáz Journal: World J Cardiol Date: 2015-09-26
Authors: Giovanni L De Maria; Niket Patel; Mathias Wolfrum; Gregor Fahrni; George Kassimis; Italo Porto; Sam Dawkins; Robin P Choudhury; John C Forfar; Bernard D Prendergast; Keith M Channon; Rajesh K Kharbanda; Hector M Garcia-Garcia; Adrian P Banning Journal: Coron Artery Dis Date: 2017-05 Impact factor: 1.439
Authors: William F Fearon; Kozo Okada; Jon A Kobashigawa; Yuhei Kobayashi; Helen Luikart; Sean Sana; Tiffany Daun; Steven A Chmura; Seema Sinha; Garett Cohen; Yasuhiro Honda; Michael Pham; David B Lewis; Daniel Bernstein; Alan C Yeung; Hannah A Valantine; Kiran Khush Journal: J Am Coll Cardiol Date: 2017-06-13 Impact factor: 24.094
Authors: Anne Bethke; Limalanathan Shanmuganathan; Geir Øystein Andersen; Jan Eritsland; David Swanson; Nils Einar Kløw; Pavel Hoffmann Journal: Eur Radiol Date: 2018-07-06 Impact factor: 5.315