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AIMS: Predicting the likely success of primary PCI to salvage potential infarcted myocardium is desirable. We compared early invasive parameters of coronary microcirculation function with the levels of circulating endothelin (ET-1) and 6-month ejection fraction after STEMI. METHODS AND RESULTS: Forty-four STEMI patients underwent assessment of coronary flow reserve (CFR) and index of myocardial resistance (IMR) on completion of PPCI and one day later. Cardiac magnetic resonance (CMR) at 24 h and 6 months assessed ejection fraction, oedema, late gadolinium enhancement, and salvage. In patients with depressed EF, there was no difference in IMR or CFR measured immediately after PPCI compared with those with preserved EF. However, by Day 1, CFR was significantly lower in those with depressed EF [2.0(1.5-2.3) vs. 2.6(2.1-3.3), P = 0.008]. In multivariable models, higher CFR post-PPCI [EST: +8.9 (SE 3.7) per 1 CFR unit, P = 0.03] and greater increase in CFR between post-PPCI and Day 1 [EST: +8.5 (SE 3.4) per 1 CFR unit, P = 0.01] were associated with higher salvage index. Circulating endothelin levels were significantly elevated in the low EF group at both 6 and 24 h, and 24 h levels correlated with CFR. CONCLUSION: Changes of the coronary microcirculation in the first day after PPCI are associated with 6-month ejection fraction and myocardial salvage. Depressed CFR at 24 h is associated with CMR imaging indices of MVO and haemorrhage and elevated endothelin levels.

Original publication

DOI

10.1093/eurheartj/eht434

Type

Journal article

Journal

Eur Heart J

Publication Date

01/08/2014

Volume

35

Pages

1971 - 1980

Keywords

Angioplasty, Blood flow, Magnetic resonance imaging, Microcirculation, Myocardial infarction, Coronary Circulation, Coronary Occlusion, Coronary Vessels, Endothelin-1, Female, Hemorrhage, Humans, Magnetic Resonance Angiography, Male, Microcirculation, Microvessels, Middle Aged, Myocardial Infarction, Percutaneous Coronary Intervention, Prospective Studies, Recovery of Function, Stroke Volume, Vascular Resistance