Coronary Flow Reserve in Non-Infarcted Myocardium Predicts Long-Term Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention

Yonsei Med J. 2018 Mar;59(2):252-257. doi: 10.3349/ymj.2018.59.2.252.

Abstract

Purpose: Coronary flow reserve (CFR) is recognized as an indicator of myocardial perfusion. The aim of this study was to assess the relationship between CFR in the non-infarcted myocardium and the incidence of major adverse cardiac events (MACEs).

Materials and methods: 100 consecutive patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) were enrolled in the present study, and divided into MACE and non-MACE groups according to the incidence of 12-month MACEs. Left ventricular function and CFR were analyzed using two-dimensional echocardiography and myocardial contrast echocardiography at one week after PCI. Cardiac troponin I levels were assayed to estimate peak concentrations thereof.

Results: The MACE group was associated with lower CFR, compared to the non-MACE group (2.41 vs. 2.77, p<0.001). In the multivariable model, CFR in the non-infarcted myocardium was an independent predictor of 12-month MACE (hazard ratio: 0.093, 95% confidence interval: 0.020-0.426, p=0.002) after adjustment for baseline demographic and clinical characteristics.

Conclusion: CFR in the non-infarcted myocardium is a useful marker for predicting 12-month MACEs in patients with AMI undergoing primary PCI.

Keywords: Myocardial infarction; coronary flow reserve; microvascular dysfunction; myocardial contrast echocardiography.

MeSH terms

  • Aged
  • Coronary Circulation / physiology*
  • Echocardiography*
  • Female
  • Fractional Flow Reserve, Myocardial
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / physiopathology*
  • Myocardial Infarction / surgery*
  • Myocardial Perfusion Imaging
  • Myocardium / pathology*
  • Percutaneous Coronary Intervention*
  • Proportional Hazards Models
  • Treatment Outcome
  • Ventricular Function, Left / physiology*