Kritya M, Sella G, Kharsa C
… +9 more, Olek D, Teh BS, Anwaar MF, Elias J, El Hajj E, Raizner AE, Farach A, Kleiman NS, Shah AR
Cardiovasc Revasc Med
· 2025 Nov · PMID 41274858
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BACKGROUND: In-stent restenosis (ISR) remains a significant clinical challenge after percutaneous coronary intervention (PCI), especially in patients with diabetes mellitus. Intravascular brachytherapy (IVBT) has re-emer...BACKGROUND: In-stent restenosis (ISR) remains a significant clinical challenge after percutaneous coronary intervention (PCI), especially in patients with diabetes mellitus. Intravascular brachytherapy (IVBT) has re-emerged as a treatment for ISR, but data on its effectiveness in patient with diabetes remain limited. METHODS: This single-center retrospective cohort study with patients undergoing IVBT for ISR. Patients were stratified according to diabetes status. The primary outcome was target lesion revascularization (TLR), with secondary endpoints including MACE, all-cause mortality, myocardial infarction (MI), and heart failure hospitalization (HFH). Statistical analysis was performed using Program R version 4.4.2. RESULTS: Out of 227 patients, 145 (64 %) had diabetes. Baseline and procedural characteristics were generally comparable between diabetic and non-patient with diabetes. Diabetes was independently associated with higher long-term mortality (HR 3.67, 95 % CI: 1.43-9.40; p = 0.007) but not with TLR, MACE, MI, or HFH. Additional stenting (HR 3.27, p = 0.0038) and female sex (HR 3.33, p = 0.016) were also associated with increased mortality. RMST analysis demonstrated shorter 5-year survival in diabetics (-0.80 years, p < 0.001). Spline modeling revealed a non-linear increase in mortality risk with age, particularly beyond 70 years. CONCLUSIONS: Among patients undergoing IVBT for ISR, diabetes was independently associated with increased mortality but not with ischemic and heart failure outcomes. Mortality-focused risk stratification and further studies incorporating glycemic and inflammatory markers are needed to optimize outcomes in this high-risk group.
Desai AV, Connolly JE, Rani R
… +3 more, Minhas AS, Johnston P, Rahman F
Cardiovasc Revasc Med
· 2026 Feb · PMID 41242909
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Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains a leading cause of in-hospital mortality. While early use of the microaxial flow pump (mAFP) has been associated with improved survival in ran...Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains a leading cause of in-hospital mortality. While early use of the microaxial flow pump (mAFP) has been associated with improved survival in randomized trials of carefully selected ST-elevation myocardial infarction (STEMI) patients, its effectiveness in broader, real-world practice is uncertain. Using the National Inpatient Sample from 2016 to 2021, we conducted a retrospective observational cohort study of adult hospitalizations with AMI-CS undergoing percutaneous coronary intervention (PCI) on the first hospital day. Patients with missing demographic or outcome data, cardiac arrest, severe valvular disease, severe dementia, or left ventricular thrombus were excluded. Among an estimated 90,070 weighted hospitalizations, 15.5 % received mAFP within 24 h of admission. Compared with those who did not, patients treated with early mAFP were younger, more frequently male and White, and more often admitted to private for-profit hospitals. After multivariable adjustment for demographics, comorbidities, and prior interventions, early mAFP was associated with higher odds of in-hospital mortality (adjusted odds ratio [aOR] 2.31; 95 % CI, 2.09-2.54), invasive mechanical ventilation (aOR 1.51; 95 % CI, 1.38-1.65), major bleeding (aOR 2.52; 95 % CI, 2.27-2.80), and acute kidney injury requiring dialysis (aOR 2.58; 95 % CI, 2.11-3.16). Results were consistent across subgroups of STEMI-CS and NSTEMI-CS and when comparisons included other early forms of mechanical circulatory support. In this nationally representative analysis, early mAFP placement in AMI-CS was associated with worse outcomes, underscoring the importance of refined patient selection and highlighting the need for further research to define its optimal role in clinical practice.
Elbenawi H, Doma M, Cangut B
… +20 more, Abdelgalil MS, Khlidj Y, Thakurathi P, Hammad A, Mohammed F, Almaadawy O, Farhoud H, Ghaly R, Khan U, Abdelkarim I, Zaaya M, Ibrahim R, Aqtash O, Sadek YA, Al-Azizi KM, Lin CJ, Goldsweig AM, Elbadawi A, Stone GW, Elgendy IY
BACKGROUND: Percutaneous micro-axial flow pumps (mAFP) are increasingly used for hemodynamic support during high-risk percutaneous coronary interventions (PCI) despite limited evidence supporting their effectiveness. We...BACKGROUND: Percutaneous micro-axial flow pumps (mAFP) are increasingly used for hemodynamic support during high-risk percutaneous coronary interventions (PCI) despite limited evidence supporting their effectiveness. We conducted a meta-analysis to assess the effectiveness and safety of mAFP use during non-emergent high-risk PCI procedures. METHODS: Electronic databases were searched for studies comparing percutaneous mAFP versus control for non-emergent high-risk PCI. The primary outcome was the incidence of major adverse cardiac events (MACE). RESULTS: Eight studies (one randomized, seven observational) with 4688 patients were included. There were no significant differences in the risk of MACE within 30 days (risk ratio [RR] 1.30, 95% confidence interval [CI] 0.81-2.10) or at 1 year (RR 1.08; 95 % CI 0.58-1.98) in patients treated with vs. without a mAFP during high-risk PCI. Nor was the risk of mortality different between groups. Peri-procedural complications, including acute kidney injury, major bleeding, blood transfusions, myocardial infarction, and stroke, were not increased with the mAFP. The subgroup of patients who received mAFP prior to PCI again had similar risk of MACE and mortality compared with the control. However, in this group, mAFP use was associated with higher in-hospital risks of major bleeding (RR 2.77; 95 % CI 1.28-5.98), blood transfusion (RR 2.20; 95 % CI 1.17-4.15) and in-hospital or 30-day myocardial infarction (RR 1.68; 95 % CI 1.03-2.73). CONCLUSIONS: mAFP use was not associated with improved outcomes among patients undergoing non-emergent high-risk PCI. Given the potential for selection bias, ongoing large-scale randomized trials are necessary to determine its impact on efficacy and safety. SOCIAL MEDIA ABSTRACT: In 4688 patients undergoing non-emergent high-risk PCI, use of a percutaneous micro-axial flow pump did not reduce MACE or mortality at 30 days or 6 months, and pre-PCI use was linked to higher risks of bleeding and in-hospital MI, warranting further large-scale trials.
Cardiovasc Revasc Med
· 2025 Nov · PMID 41207801
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BACKGROUND: Metastasis is a key hallmark of cancer progression and significantly affects the management of other comorbidities, including coronary artery disease (CAD). Perioperative outcomes of elective percutaneous cor...BACKGROUND: Metastasis is a key hallmark of cancer progression and significantly affects the management of other comorbidities, including coronary artery disease (CAD). Perioperative outcomes of elective percutaneous coronary intervention (PCI) for patients with metastatic cancer have not been thoroughly investigated. This study aimed to provide a comprehensive, population-based analysis of in-hospital outcomes of elective PCI among patients with metastatic cancer using a national database. METHODS: Adult patients who underwent elective PCI were identified by ICD-10-PCS codes in National Inpatient Sample from Q4 2015-2021. Patients who had concomitant procedures were excluded. A 1:3 propensity-score matching was used to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer status between patients with and without metastatic cancer. In-hospital outcomes were examined. RESULTS: Among 44,654 patients who underwent elective PCI, 233 (0.50 %) had metastatic cancer. After propensity-score matching, all patients with metastatic cancer were matched to 671 controls. Metastatic cancer patients had higher mortality (7.17 % vs 2.09 %, p < 0.01), cardiogenic shock (11.21 % vs 5.66 %, p = 0.01), mechanical ventilation (14.35 % vs 4.02 %, p < 0.01), acute kidney injury (AKI; 24.66 % vs 17.59 %, p = 0.02), hemorrhage/hematoma (25.11 % vs 9.84 %, p < 0.01), infection (8.07 % vs 1.79 %, p < 0.01), and transfer out (17.49 % vs 9.24 %, p < 0.01). In addition, metastatic cancer patients had longer length of stay (p < 0.01) and higher total hospital charges (p < 0.01). Significant morbidities associated with in-hospital mortality metastatic cancer patients included pericardial complications (aOR 75.91, p < 0.01), mechanical ventilation (aOR 28.09, p < 0.01), and AKI (aOR 12.53, p < 0.01). CONCLUSION: Considering their elevated risks of in-hospital mortality and morbidities, elective PCI should be carefully considered in metastatic cancer patients. These findings could help guide preprocedural counseling, clinical decision-making, and goals of care discussion for these patients. Early identification and management of morbidities, particularly pericardial complications, may help reduce early mortality in these patients.
Sato M, Sakakura K, Jinnouchi H
… +9 more, Taniguchi Y, Yamamoto K, Tsukui T, Hatori M, Kasahara T, Watanabe Y, Ishibashi S, Seguchi M, Fujita H
Cardiovasc Revasc Med
· 2025 Nov · PMID 41203445
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BACKGROUND: Primary percutaneous coronary intervention (PCI) has improved the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). However, radiation skin damage is one of serious complications...BACKGROUND: Primary percutaneous coronary intervention (PCI) has improved the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). However, radiation skin damage is one of serious complications in primary PCI. The purpose of this study was to identify the determinants of the excess radiation dose in primary PCI. METHODS: We included 1126 patients with STEMI and divided them into an excess radiation group (n = 61; peak skin dose ≥2 Gy) and a standard radiation group (n = 1065; peak skin dose <2 Gy). Univariate and multivariate logistic regression analyses were performed to find patient or procedural factors associated with excess radiation. RESULTS: In patient factors, body mass index (BMI) was significantly associated with excess radiation [odds ratio (OR) 1.09, 95 % confidence interval (CI) 1.01-1.18, P = 0.022] after controlling for confounding factors. In procedural factors, use of intra-aortic balloon pumping (OR 2.12, 95 % CI 1.05-4.27, P = 0.035), number of used guidewire (OR 1.70, 95 % CI 1.26-2.31, P < 0.001), number of used balloon (OR 1.50, 95 % CI 1.18-1.92, P = 0.001), total length of stents (OR 1.25, 95 % CI 1.09-1.44, P = 0.002), use of microcatheters (OR 2.18, 95 % CI 1.13-4.21, P = 0.02) and thrombus aspiration (OR 3.86, 95 % CI 2.07-7.20, P < 0.001) were significantly associated with excess radiation after controlling for confounding factors. CONCLUSIONS: In primary PCI for STEMI, high BMI and using many devices were significantly associated with excess radiation. We should pay special attention to patients with high BMI and complex lesions which require many devices to prevent excess skin radiation.
Once considered "benign", secondary tricuspid regurgitation (sTR) as a consequence of left-sided heart disease or pulmonary hypertension is both frequent and prognostically important. However, severe sTR is under-treated...Once considered "benign", secondary tricuspid regurgitation (sTR) as a consequence of left-sided heart disease or pulmonary hypertension is both frequent and prognostically important. However, severe sTR is under-treated, as it may remain asymptomatic for an extended period and may lead to irreversible right ventricular (RV) and end-organ damage. Existing guideline recommendations tend to be conservative, often suggesting intervention late, which stems largely from the high mortality risk associated historically with tricuspid valve (TV) surgery. Over time, this results in right heart failure (RHF) and increases the mortality risk associated with intervention. Similar to left heart failure, RHF is a progressive condition that can be classified into stages. As such, a similar staging system, that incorporates both RV remodelling and the clinical manifestations of RHF has been proposed for risk stratification of these patients, and it may be helpful in guiding the optimal timing for intervention in asymptomatic severe TR.
Dreher L, Nabi HA, Bcharah G
… +8 more, Raslan MA, Abdelnabi M, Bcharah H, Baudhuin LM, Wang G, Osundiji MA, Ayoub C, Shamoun FE
Cardiovasc Revasc Med
· 2025 Oct · PMID 41173753
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BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, particularly in younger women, and is frequently associated with systemic vascular abnormalities....BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, particularly in younger women, and is frequently associated with systemic vascular abnormalities. However, the prevalence and clinical significance of ascending aortic dilation in SCAD remain poorly defined. METHODS: We conducted a retrospective, multicenter cohort study of patients ≥20 years old with angiographically confirmed SCAD at Mayo Clinic campuses from 2018 to 2024. Transthoracic echocardiography was used to measure aortic dimensions at the sinus of Valsalva and mid-ascending aorta, with dilation defined by age-, sex-, and body surface area-adjusted reference values. RESULTS: Among 937 patients with SCAD, 189 (20.2 %) demonstrated ascending aortic dilation. Dilation was most commonly located at the mid-ascending aorta (70.9 %). Prevalence increased with age (p = 0.009) and was significantly associated with hypertension (48.7 % in the dilation group vs. 33.3 % in the non-dilated group, p < 0.001). Patients with aortic dilation also had higher rates of extracoronary aneurysms, particularly involving the celiac, splenic, and splanchnic arteries. Thoracic aortic dissection was rare, observed in 0.4 % of patients. CONCLUSION: Ascending aortic dilation was identified in approximately one-fifth of patients with SCAD, substantially higher than reported in the general population. These findings support SCAD as a systemic vascular disorder and highlight the potential role of baseline aortic assessment at diagnosis. The association with age and hypertension suggests both intrinsic vascular susceptibility and traditional risk factors contribute to this phenotype. Future prospective studies are needed to define progression, clinical consequences, and surveillance strategies.
Demissei BG, Sanchez AA, Sawant VS
… +12 more, Cellamare M, Zhang C, Ozturk ST, Cermak V, Verma BR, Chitturi KR, Merdler I, Hashim H, Case BC, Asch FM, Waksman R, Sadeghpour A
Cardiovasc Revasc Med
· 2025 Oct · PMID 41162270
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BACKGROUND: The pathophysiologic mechanisms underlying angina with non-obstructive coronary artery disease (ANOCA) are multifactorial, leading to myocardial injury and adverse cardiovascular events. The echocardiographic...BACKGROUND: The pathophysiologic mechanisms underlying angina with non-obstructive coronary artery disease (ANOCA) are multifactorial, leading to myocardial injury and adverse cardiovascular events. The echocardiographic phenotyping of left ventricular function in patients with ANOCA is sparse. METHODS: Of the 362 patients enrolled in the Coronary Microvascular Disease Registry (CMDR), eighty-eight ANOCA patients with available transthoracic echocardiograms were included in this cross-sectional study, after excluding patients with poor image quality and those with LVEF ≤40 %. Artificial intelligence-assisted quantitative echocardiography analysis, with additional meticulous tracking inspection as necessary, was performed using the Us2.v2 platform. FDA-approved/cleared parameters of left ventricular deformation, wall thickness, and diastolic function were evaluated. Left atrial (LA) reservoir strain was quantified manually by an experienced echocardiographer. RESULTS: The mean age was 60 years (SD: 12), 72.7 % were female, and 65.5 % were Black. The mean LVEF was 60.4 % (SD: 6.5); 81.2 % of the patients had LVEF>55 %. Global longitudinal strain (GLS) was abnormal, as defined by GLS < 18 %, in 47.6 % of the patients. The majority (56 % to 70 %) had abnormal septal e' velocity (<7 cm/s), lateral e' velocity (<10 cm/s), and abnormal/borderline E/e' (≥8). LA reservoir strain was abnormal (<39 %) in 60 % of the patients. The proportion of patients with peak tricuspid regurgitation velocity > 2.8 m/s and LA volume index >34 mL/m, suggesting significant diastolic impairment, was 10.4 % and 7.9 %. Abnormal interventricular septum and posterior wall diameters (>1.1 cm) were observed in 32.9 % and 23.5 %, respectively. CONCLUSION: Our findings demonstrate a high prevalence of cardiac abnormalities, utilizing echocardiographic myocardial deformation parameters in patients with ANOCA.
Hoyos C, Upadhaya S, Jabri A
… +9 more, Boyapati SP, Billa S, Farhan S, Anker A, Cox P, Sanina C, Soltero-Mariscal E, Spinetto PV, Wiley JM
Cardiovasc Revasc Med
· 2026 Jun · PMID 41145332
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BACKGROUND: Tricuspid regurgitation (TR) is a common valvular disorder linked to significant morbidity and mortality. Transcatheter tricuspid valve intervention (TTVI) has emerged as a novel therapeutic option for high-r...BACKGROUND: Tricuspid regurgitation (TR) is a common valvular disorder linked to significant morbidity and mortality. Transcatheter tricuspid valve intervention (TTVI) has emerged as a novel therapeutic option for high-risk patients. However, randomized controlled trials (RCTs) evaluating its clinical efficacy remain limited in sample size, making it difficult to draw definitive conclusions. METHODS: We conducted a systematic review of studies comparing outcomes between TTVI vs. optimal medical therapy (OMT) published between January 2000 to June 2025 in PubMed, Cochrane, and Embase. The primary outcomes were all-cause mortality and heart failure hospitalization (HFH). The secondary outcomes included cardiovascular death, TR severity, NYHA class improvement, and Kansas City Cardiomyopathy Questionnaire (KCCQ) score. RESULTS: Three RCTs, including 1264 patients (TTVI: 696; OMT: 568), were analyzed. At one year, there was no significant difference in all-cause mortality (RR: 1.12; 95 % CI: 0.77-1.63; p = 0.55), HFH (RR: 0.83; 95 % CI: 0.64-1.07; p = 0.15) and cardiovascular death (RR: 1.11; 95 % CI: 0.7-1.77; p = 0.65) between groups. Patients in TTVI group significantly improved at least 1 class in NYHA functional classification (RR: 2.77; 95 % CI: 1.72-4.49; p < 0.0001), had greater changes in KCCQ scores (+15.23 points; 95 % CI: 12.03-18.44; p < 0.0001), and markedly reduced the incidence of ≥ severe TR at follow-up (RR: 0.09; 95 % CI: 0.03-0.27; p < 0.0001) compared to OMT. CONCLUSIONS: Although TTVI has not demonstrated statistically significant reductions in all-cause mortality or HFH, it is associated with substantial improvements in functional class, quality of life, and TR severity, supporting its role in select high-risk patients.
Asada S, Kawasaki T, Serikawa S
… +12 more, Yamamoto T, Abe K, Hidaka M, Soejima T, Fukami Y, Haraguchi K, Hirai K, Fukuoka R, Orita Y, Umeji K, Koga H, Yamabe H
Cardiovasc Revasc Med
· 2025 Oct · PMID 41139568
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BACKGROUND: While a high Agatston score in patients with highly calcified lesions undergoing elective percutaneous coronary intervention (PCI) may be associated with clinical outcomes, the specific impact of the Agatston...BACKGROUND: While a high Agatston score in patients with highly calcified lesions undergoing elective percutaneous coronary intervention (PCI) may be associated with clinical outcomes, the specific impact of the Agatston score, particularly when measured in the target vessel, on PCI outcomes remains unclear. This study aimed to investigate the value of the Agatston score in the target vessel for the prediction of clinical outcomes in patients with highly calcified coronary artery lesions undergoing PCI with atherectomy. METHODS: A total of 345 patients who underwent elective PCI with atherectomy were classified into two groups on the basis of the quartiles of the Agatston score, as measured by coronary computed tomography angiography (CCTA) prior to the procedure: the low-to-intermediate Agatston score group (Q1-Q3: n = 107) and the high Agatston score group (Q4: n = 36). Event-free survival curves were generated using the Kaplan-Meier method, and statistical differences were assessed using the log-rank test. Additionally, multivariate Cox hazard analysis was performed to examine the association between a high Agatston score and major adverse cardiac events (MACE). RESULTS: In the multivariate Cox hazard analysis, a high Agatston score was significantly associated with MACE (HR 2.073, 95 % CI 1.055-4.074, P = 0.034) after adjusting for potential confounders. CONCLUSIONS: A high Agatston score was significantly associated with mid- to long-term clinical outcomes. The Agatston score of the target vessel, as assessed by CCTA prior to the procedure, may serve as a prognostic marker for mid- to long-term outcomes in patients undergoing elective PCI with atherectomy.
Jabri A, Kumar S, Abbas A
… +12 more, Fang JX, Madanat L, Grossman P, Seth M, Chetcuti S, Mantey J, Suri R, Vivacqua A, Schwann T, Dixon S, Sukul D, Villablanca PA
Cardiovasc Revasc Med
· 2026 Jun · PMID 41125469
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BACKGROUND: Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) is used for degenerated surgical bioprosthetic valves. Comparative outcomes between balloon-expandable valves (BEV) and self-expanding valves (...BACKGROUND: Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) is used for degenerated surgical bioprosthetic valves. Comparative outcomes between balloon-expandable valves (BEV) and self-expanding valves (SEV) remain scarce, particularly regarding long-term survival. METHODS: We conducted a retrospective cohort study using data from the Michigan Structural Heart Consortium (MISHC), a multicenter collaborative focused on quality improvement for structural heart interventions. Clinical outcomes, including mortality, were evaluated. Logistic regression adjusted for age, gender, and STS risk score assessed in-hospital, 30-day, and 1-year mortality. Kaplan-Meier and Cox regression analyzed five-year survival with similar adjustments. RESULTS: Between 2013 and 2023, 1394 patients underwent ViV TAVR, with 683 (49.0 %) being BEV and 711 (51.0 %) being SEV. Patients who received BEV demonstrated significantly lower pre-procedural mean aortic gradients than those receiving SEV (35.94 ± 16.20 vs. 39.11 ± 16.17 mmHg, p = 0.002) and larger pre-procedural aortic valve areas (0.94 ± 0.55 cm BEV vs. 0.85 ± 0.40 cm SEV; p = 0.005). In-hospital mortality (1.2 % vs. 3.0 %, p = 0.032) and 30-day mortality (2.2 % vs. 4.1 %, p = 0.040) were significantly lower with BEV after ViV TAVR. Severe patient-prosthesis mismatch (PPM) was higher with BEV than SEV (47.9 % vs. 24.3 %, p < 0.001). At one year, mortality did not differ significantly (8.6 % BEV vs. 8.2 % SEV, p = 0.495). Five-year survival rates were similar between groups (p = 0.880). CONCLUSION: In ViV TAVR, no significant survival differences were observed at 5-year follow-up, despite a higher prevalence of severe PPM in the BEV group.
Fukano K, Sasabuchi Y, Matsui H
… +4 more, Iizuka Y, Yamaguchi A, Sanui M, Yasunaga H
Cardiovasc Revasc Med
· 2025 Oct · PMID 41125468
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BACKGROUND: The optimal strategy for acute type A aortic dissection (ATAAD) with coronary malperfusion remains unclear. This study aimed to compare in-hospital mortality between coronary angiography followed by aortic re...BACKGROUND: The optimal strategy for acute type A aortic dissection (ATAAD) with coronary malperfusion remains unclear. This study aimed to compare in-hospital mortality between coronary angiography followed by aortic repair and direct aortic repair without coronary angiography in patients with ATAAD and coronary malperfusion. METHODS: We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database, a nationwide inpatient database, from July 2010 to March 2022. We included patients who were admitted emergently and underwent surgery for ATAAD on the day of admission. Patients were defined as having preoperative coronary malperfusion if they had a diagnosis of acute myocardial infarction present on admission or underwent coronary angiography or percutaneous coronary intervention on the day of surgery. The primary outcome was in-hospital mortality. Patients were categorized as coronary angiography followed by aortic repair (CAG group) or direct aortic repair (DAR group). A multivariable Cox regression model was used to compare the time to in-hospital death between groups. RESULTS: We identified 1167 patients with ATAAD with coronary malperfusion. Of these, 508 (43.5 %) were in the CAG group and 659 (56.5 %) were in the DAR group. Cox regression analysis revealed no significant differences in the in-hospital mortality between the groups (hazard ratio, 1.05; 95 % confidence interval, 0.83 to 1.34, p = 0.661). CONCLUSIONS: Among patients with ATAAD with coronary malperfusion, in-hospital mortality did not differ significantly between those who underwent coronary angiography followed by aortic repair and those who underwent direct aortic repair.
Trøan J, Bendix K, Saaby L
… +5 more, Veien KT, Ellert-Gregersen J, Søndergaard EV, Junker A, Jensen LO
Cardiovasc Revasc Med
· 2025 Oct · PMID 41093712
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BACKGROUND: In patients with ST-elevation myocardial infarction (STEMI), coronary microcirculatory dysfunction (CMD) may predict the risk of heart failure and mortality, and can be assessed by the index of microcirculato...BACKGROUND: In patients with ST-elevation myocardial infarction (STEMI), coronary microcirculatory dysfunction (CMD) may predict the risk of heart failure and mortality, and can be assessed by the index of microcirculatory resistance (IMR) and the more novel index, microvascular resistance reserve (MRR). We investigated MRR measurements and its relationship with left ventricular function changes assessed by cardiac magnetic resonance (CMR). METHODS: In 26 patients with STEMI and single-vessel disease treated with primary percutaneous coronary intervention (PPCI), invasive flow- and pressure measurements were performed after PPCI and repeated after 3 months. CMR was performed within 72 h of PPCI and after 3 months. CMD was defined as MRR ≤ 3 and patients were divided into two groups: MRR ≤ 3 and MRR > 3, as well as into IMR ≥ 40 and IMR < 40. Six years clinical follow-up was conducted in all patients. RESULTS: Median MRR after PPCI was 2.6 [Interquartile range (IQR) 1.5, 4.0] and 15 patients (58 %) had a MRR ≤ 3, while median IMR was 33 [IQR 13, 79]. Patients with MRR ≤ 3 had significantly greater infarct size (IS) at both index (IS(late gadolinium enhancement (LGE)): median 1796 [IQR 827, 4167] vs 788 [IQR 308, 1201], p = 0.024) and at 3-month follow-up (IS(LGE): median 928 [IQR 566, 2024] vs 232 [IQR 82, 807], p = 0.027) compared to patients with MRR > 3. Assessing the CMD with IMR, IS did not differ significantly, neither at baseline (IMR ≥ 40 IS(LGE) median: 1483 [IQR 827, 4167] vs IMR < 40,870 [IQR 310, 2000], p = 0.21) nor at 3-month follow-up (IS(LGE): median 824 [IQR 587, 1850] vs 566 [IQR 107, 834], p = 0.22). After six years, two patients died (one cardiac cause), and one patient was hospitalized for heart failure, all patients had MRR ≤ 3. CONCLUSIONS: In this small pilot study, patients with STEMI and MRR ≤ 3 had significantly greater IS after PPCI and after 3 months compared to patients with MRR > 3, while IS did not differ in IMR groups.