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The Index of Microcirculatory Resistance Predicts Myocardial Infarction Related to Percutaneous Coronary Intervention.
MedLine Citation:
PMID:  22874078     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: PERIPROCEDURAL MYOCARDIAL INFARCTION (MI) OCCURS IN A SIGNIFICANT PROPORTION OF PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION (PCI) AND PORTENDS POOR OUTCOMES. CURRENTLY, NO CLINICALLY APPLICABLE METHOD PREDICTS PERIPROCEDURAL MI IN THE CARDIAC CATHETERIZATION LABORATORY BEFORE IT OCCURS. WE HYPOTHESIZED THAT IMPAIRED BASELINE CORONARY MICROCIRCULATORY RESERVE, WHICH REDUCES THE ABILITY TO TOLERATE ISCHEMIC INSULTS, IS A RISK FOR PERIPROCEDURAL MI AND THAT THE INDEX OF MICROCIRCULATORY RESISTANCE (IMR) MEASURED DURING PCI CAN PREDICT OCCURRENCE OF PERIPROCEDURAL MI.METHODS AND RESULTS: CONSECUTIVE PATIENTS UNDERGOING ELECTIVE PCI OF A SINGLE LESION IN THE LEFT ANTERIOR DESCENDING CORONARY ARTERY WERE RECRUITED. A PRESSURE-TEMPERATURE SENSOR WIRE WAS USED TO MEASURE IMR BEFORE PCI. OF THE 50 PATIENTS STUDIED, 10 HAD PERIPROCEDURAL MI. FROM BINARY LOGISTIC REGRESSION ANALYSES OF ALL CLINICAL, PROCEDURAL, AND PHYSIOLOGICAL PARAMETERS, UNIVARIABLE PREDICTORS OF PERIPROCEDURAL MI WERE PRE-PCI IMR (P=0.003) AND THE NUMBER OF STENTS USED (P=0.039). PRE-PCI IMR WAS THE ONLY INDEPENDENT PREDICTOR IN BIVARIABLE REGRESSION ANALYSES PERFORMED BY ADJUSTING FOR EACH AVAILABLE COVARIATE ONE AT A TIME (ALL P0.02). PRE-PCI IMR 27 U HAD 80.0% SENSITIVITY AND 85.0% SPECIFICITY FOR PREDICTING PERIPROCEDURAL MI (C STATISTIC, 0.80; P=0.003). PRE-PCI IMR 27 U WAS INDEPENDENTLY ASSOCIATED WITH A 23-FOLD RISK OF DEVELOPING PERIPROCEDURAL MI (ODDS RATIO, 22.7; 95% CI, 3.8133.9).CONCLUSIONS: These data suggest that the status of the coronary microcirculation plays a role in determining susceptibility toward periprocedural MI at the time of elective PCI. The IMR can predict subsequent risk of developing myocardial necrosis and may guide adjunctive prevention strategies.
Authors:
Martin K C Ng; Andy S C Yong; Michael Ho; Maulik G Shah; Chirapan Chawantanpipat; Rachel O'Connell; Anthony Keech; Leonard Kritharides; William F Fearon
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-8
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  -     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Cardiology, Royal Prince Alfred Hospital; Department of Cardiology, Concord Repatriation General Hospital; and National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia; and Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA.
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