Takeshi Nishi1, Tadashi Murai2, Giovanni Ciccarelli3, Sonia V Shah1, Yuhei Kobayashi1, François Derimay1, Katsuhisa Waseda4, Avalon Moonen5,6, Masahiro Hoshino2, Atsushi Hirohata7, Andy S C Yong5,6, Martin K C Ng6,8, Tetsuya Amano4, Emanuele Barbato3,9, Tsunekazu Kakuta2, William F Fearon1. 1. Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, CA (T.N., S.V.S., Y.K., F.D., W.F.F.). 2. Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (T.M., M.H., T.K.). 3. Cardiovascular Center Aalst, Belgium (G.C., E.B.). 4. Department of Cardiology, Aichi Medical University, Nagakute, Japan (K.W., T.A.). 5. Department of Cardiology, Concord Hospital, Sydney, Australia (A.M., A.S.C.Y.). 6. Sydney Medical School, The University of Sydney, Australia (A.M., A.S.C.Y., M.K.C.N.). 7. Department of Cardiovascular Medicine, Sakakibara Heart Institute of Okayama, Japan (A.H.). 8. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia (M.K.C.N.). 9. Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.).
Abstract
BACKGROUND: The prognostic impact of coronary microvascular dysfunction after percutaneous coronary intervention (PCI) remains unclear in patients with stable coronary artery disease. This study sought to investigate the prognostic value of microvascular function measured immediately after PCI in patients with stable coronary artery disease. METHODS: We enrolled 572 patients with stable coronary artery disease who underwent PCI and elective measurement of the index of microcirculatory resistance (IMR) immediately after PCI from 8 centers in 4 countries. Impaired microvascular function was defined as IMR≥25 (high IMR). Major adverse cardiac events, including death, myocardial infarction (MI) and target vessel revascularization, were evaluated. RESULTS: During a median follow-up duration of 4.0 years, the cumulative major adverse cardiac events rate was significantly higher in the high IMR group (n=66/148) compared with the low IMR group (n=128/424; hazard ratio [HR], 1.56; 95% CI, 1.16-2.105; P=0.001), primarily due to a higher rate of periprocedural MI (HR, 1.59; 95% CI, 1.11-2.28; P=0.004) but also due to higher rates of mortality (HR, 1.59; 95% CI, 0.76-3.35; P=0.22), spontaneous MI (HR, 2.10; 95% CI, 0.67-6.63; P=0.20) and target vessel revascularization (HR, 1.40; 95% CI, 0.77-2.54; P=0.27). Cumulative risk for death, spontaneous MI, and target vessel revascularization was higher in the high IMR group (HR, 1.55; 95% CI, 0.99-2.43; P=0.056), as was death and spontaneous MI alone (HR, 1.79; 95% CI, 0.96-3.36; P=0.065). On multivariable analysis, high IMR post-PCI was an independent predictor of major adverse cardiac events. CONCLUSIONS: IMR measured immediately after PCI predicts adverse events in patients with stable coronary artery disease.
BACKGROUND: The prognostic impact of coronary microvascular dysfunction after percutaneous coronary intervention (PCI) remains unclear in patients with stable coronary artery disease. This study sought to investigate the prognostic value of microvascular function measured immediately after PCI in patients with stable coronary artery disease. METHODS: We enrolled 572 patients with stable coronary artery disease who underwent PCI and elective measurement of the index of microcirculatory resistance (IMR) immediately after PCI from 8 centers in 4 countries. Impaired microvascular function was defined as IMR≥25 (high IMR). Major adverse cardiac events, including death, myocardial infarction (MI) and target vessel revascularization, were evaluated. RESULTS: During a median follow-up duration of 4.0 years, the cumulative major adverse cardiac events rate was significantly higher in the high IMR group (n=66/148) compared with the low IMR group (n=128/424; hazard ratio [HR], 1.56; 95% CI, 1.16-2.105; P=0.001), primarily due to a higher rate of periprocedural MI (HR, 1.59; 95% CI, 1.11-2.28; P=0.004) but also due to higher rates of mortality (HR, 1.59; 95% CI, 0.76-3.35; P=0.22), spontaneous MI (HR, 2.10; 95% CI, 0.67-6.63; P=0.20) and target vessel revascularization (HR, 1.40; 95% CI, 0.77-2.54; P=0.27). Cumulative risk for death, spontaneous MI, and target vessel revascularization was higher in the high IMR group (HR, 1.55; 95% CI, 0.99-2.43; P=0.056), as was death and spontaneous MI alone (HR, 1.79; 95% CI, 0.96-3.36; P=0.065). On multivariable analysis, high IMR post-PCI was an independent predictor of major adverse cardiac events. CONCLUSIONS: IMR measured immediately after PCI predicts adverse events in patients with stable coronary artery disease.
Authors: Andreas Seraphim; Benjamin Dowsing; Krishnaraj S Rathod; Hunain Shiwani; Kush Patel; Kristopher D Knott; Sameer Zaman; Ieuan Johns; Yousuf Razvi; Rishi Patel; Hui Xue; Daniel A Jones; Marianna Fontana; Graham Cole; Rakesh Uppal; Rhodri Davies; James C Moon; Peter Kellman; Charlotte Manisty Journal: J Am Coll Cardiol Date: 2022-03-29 Impact factor: 27.203
Authors: Monika Kodeboina; Sakura Nagumo; Daniel Munhoz; Jeroen Sonck; Niya Mileva; Emanuele Gallinoro; Alessandro Candreva; Takuya Mizukami; Frederik Van Durme; Alex Heyse; Eric Wyffels; Marc Vanderheyden; Emanuele Barbato; Jozef Bartunek; Bernard De Bruyne; Carlos Collet Journal: J Interv Cardiol Date: 2021-06-02 Impact factor: 2.279
Authors: Takeshi Nishi; Tadashi Murai; Katsuhisa Waseda; Atsushi Hirohata; Andy S C Yong; Martin K C Ng; Tetsuya Amano; Emanuele Barbato; Tsunekazu Kakuta; William F Fearon Journal: Int J Cardiol Heart Vasc Date: 2021-07-14