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Index of Microcirculatory Resistance at the Time of Primary Percutaneous Coronary Intervention Predicts Early Cardiac Complications: Insights From the OxAMI (Oxford Study in Acute Myocardial Infarction) Cohort
- Source :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
- Publication Year :
- 2017
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2017.
-
Abstract
- Background Early risk stratification after primary percutaneous coronary intervention ( PPCI ) for ST ‐segment–elevation myocardial infarction is currently challenging. Identification of a low‐risk group may improve triage of patients to alternative clinical pathways and support early hospital discharge. Our aim was to assess whether the index of microcirculatory resistance ( IMR ) at the time of PPCI can identify patients at low risk of early major cardiac complications and to compare its performance against guideline‐recommended risk scores. Methods and Results IMR was measured using a pressure–temperature sensor wire. Cardiac complications were defined as the composite of cardiac death, cardiogenic shock, pulmonary edema, malignant arrhythmias, cardiac rupture, and presence of left ventricular thrombus either before hospital discharge or within 30‐day follow‐up. In total, 261 patients undergoing PPCI who were eligible for coronary physiology assessment were prospectively enrolled. Twenty‐two major cardiac complications were reported. Receiver operating characteristic curve analysis confirmed the utility of IMR in predicting complications and showed significantly better performance than coronary flow reserve, the Primary Angioplasty in Myocardial Infarction II (PAMI‐II), and Zwolle score ( P ≤0.006). Low microvascular resistance ( IMR ≤40) was measured in 159 patients (61%) of the study population and identified all patients who were free of major cardiac complications (sensitivity: 100%; 95% CI , 80.5–100%). Conclusions IMR immediately at the end of PPCI for ST ‐segment–elevation myocardial infarction reliably predicts early major cardiac complications and performed significantly better than recommended risk scores. These novel data have implications for early risk stratification after PPCI .
- Subjects :
- Male
medicine.medical_treatment
clinical outcome
030204 cardiovascular system & hematology
Coronary Angiography
Electrocardiography
Postoperative Complications
0302 clinical medicine
Risk Factors
Prospective Studies
030212 general & internal medicine
Myocardial infarction
Prospective cohort study
Original Research
Quality and Outcomes
medicine.diagnostic_test
Incidence
Middle Aged
Coronary Vessels
Interventional Cardiology
Survival Rate
Treatment Outcome
myocardial infarction
medicine.anatomical_structure
Cohort
Cardiology
Female
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
microcirculation
Diagnostic Testing
Risk Assessment
03 medical and health sciences
Coronary circulation
Percutaneous Coronary Intervention
Coronary Circulation
Internal medicine
medicine
Humans
Survival rate
business.industry
Percutaneous coronary intervention
medicine.disease
United Kingdom
ROC Curve
Vascular resistance
ST Elevation Myocardial Infarction
Vascular Resistance
business
Acute Coronary Syndromes
Subjects
Details
- ISSN :
- 20479980
- Volume :
- 6
- Database :
- OpenAIRE
- Journal :
- Journal of the American Heart Association
- Accession number :
- edsair.doi.dedup.....2c6e907c4f8b85626eb55e8bdb08054b