Clinical Research
Myocardial Infarction
Predictive Value of the Index of Microcirculatory Resistance in Patients With ST-Segment Elevation Myocardial Infarction

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Objectives

The objective of this study is to evaluate the predictive value of the index of microcirculatory resistance (IMR) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).

Background

Despite adequate epicardial artery reperfusion, a number of patients with STEMI have a poor prognosis because of microvascular damage. Assessing the status of the microvasculature in this setting remains challenging.

Methods

In 29 patients after primary PCI for STEMI, IMR was measured with a pressure sensor/thermistor-tipped guidewire. The Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade, TIMI frame count, coronary flow reserve, and ST-segment resolution were also recorded.

Results

The IMR correlated significantly with the peak creatinine kinase (CK) (R = 0.61, p = 0.0005) while the other measures of microvascular dysfunction did not. In patients with an IMR greater than the median value of 32 U, the peak CK was significantly higher compared with those having values ≤32 U (3,128 ± 1,634 ng/ml vs. 1,201 ± 911 ng/ml, p = 0.002). The IMR correlated significantly with 3-month echocardiographic wall motion score (WMS) (R = 0.59, p = 0.002) while the other measures of microvascular function did not. The WMS at 3-month follow-up was significantly worse in the group with an IMR >32 U compared with ≤32 U (28 ± 7 vs. 20 ± 4, p = 0.001). On multivariate analysis, IMR was the strongest predictor of peak CK and 3-month WMS. The IMR was the only significant predictor of recovery of left ventricular function on the basis of the percent change in WMS (R = 0.50, p < 0.01).

Conclusions

Compared to standard measures, IMR appears to be a better predictor of microvascular damage after STEMI, both acutely and in short term follow-up.

Abbreviations and Acronyms

CFR
coronary flow reserve
CK
creatine kinase
cTFC
corrected Thrombolysis In Myocardial Infarction frame count
FFR
fractional flow reserve
IMR
index of microcirculatory resistance
PCI
percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction
TIMI
Thrombolysis In Myocardial Infarction
TMPG
Thrombolysis In Myocardial Infarction myocardial perfusion grade
WMS
wall motion score

Cited by (0)

This work was supported in part by grant 1 K23 HL072808-01A1 (to Dr. Fearon) from the National Institutes of Health, Heart, Lung, and Blood Institute, Bethesda, Maryland.