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. 2021 Oct 25;6(9-10):749-761.
doi: 10.1016/j.jacbts.2021.08.007. eCollection 2021 Sep-Oct.

Association Between Thrombogenicity Indices and Coronary Microvascular Dysfunction in Patients With Acute Myocardial Infarction

Min Gyu Kang  1 , Bon-Kwon Koo  2 , Udaya S Tantry  3 , Kyehwan Kim  1 , Jong-Hwa Ahn  4 , Hyun Woong Park  1 , Jeong Rang Park  1 , Seok-Jae Hwang  1 , Jin-Yong Hwang  1   5 , Paul A Gurbel  3 , Habib Samady  6 , Jin-Sin Koh  1 , Young-Hoon Jeong  4   5
Affiliations

Association Between Thrombogenicity Indices and Coronary Microvascular Dysfunction in Patients With Acute Myocardial Infarction

Min Gyu Kang et al. JACC Basic Transl Sci. .

Abstract

The association between thrombogenicity and coronary microvascular dysfunction (CMD) has been poorly explored in patients with acute myocardial infarction (AMI). In our real-world clinical practice (N = 116), thrombogenicity was evaluated with thromboelastography and conventional hemostatic measures, and CMD was defined as index of microcirculatory resistance of >40 U using the invasive physiologic test. High platelet-fibrin clot strength (P-FCS) (≥68 mm) significantly increased the risk of postprocedural CMD (odds ratio: 4.35; 95% CI: 1.74-10.89). Patients with both CMD and high P-FCS had a higher rate of ischemic events compared to non-CMD subjects with low P-FCS (odds ratio: 5.58; 95% CI: 1.31-23.68). This study showed a close association between heightened thrombogenicity and CMD and their prognostic implications after reperfusion in acute myocardial infarction patients.

Keywords: AMI, acute myocardial infarction; CFR, coronary flow reserve; CMD, coronary microvascular dysfunction; IMR, index of microcirculatory resistance; LASSO, least absolute shrinkage and selection operator; MA, maximum amplitude; MACE, major adverse cardiovascular events; OR, odds ratio; P-FCS, platelet-fibrin clot strength; PCI, percutaneous coronary intervention; PRU, P2Y12 reaction units; R, reaction time; TEG, thromboelastography; TIMI, Thrombolysis in Myocardial Infarction; Tmn, mean transit time; acute myocardial infarction; cardiovascular event; clot strength; coronary microvascular dysfunction; thrombogenicity.

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Conflict of interest statement

This study was supported by the Basic Science Research Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Science, ICT, and Future Planning (NRF-2015R1A5A2008833). The content is solely the responsibility of the authors and does not necessarily represent the official views of any funding agencies. Dr Gurbel has received grants and personal fees from Bayer HealthCare, Otitopic, Amgen, and Janssen, US WorldMeds; grants from Instrumentation Laboratory, Hikari Dx, Haemonetics, Medicure, and Idorsia Pharmaceuticals; and personal fees from UpToDate and has patents “Detection of Restenosis Risk in Patients Issued” and “Assessment of Cardiac Health and Thrombotic Risk in a Patient.” Dr Jeong has received honoraria for lectures from AstraZeneca, Daiichi Sankyo, Sanofi-Aventis, Han-mi Pharmaceuticals, and Yuhan Pharmaceuticals and research grants or support from Yuhan Pharmaceuticals and U and I Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Measurements from Intracoronary Physiologic Testing and Thromboelastography (A) Index of microcirculatory resistance. (B) Thromboelastography. α = the angle in degrees formed by the tangent line to the thromboelastography tracing measure at the reaction time; CFR = coronary flow reserve; EPL = estimated percent lysis; IMR = index of microcirculatory index; K = coagulation time; LY30 = percentage of the clot that has lysed 30 minutes after the time of maximum amplitude; MA = maximum amplitude; R = reaction time; Tmn = mean transit time.
Figure 2
Figure 2
Flow Diagram of the Study AMI = acute myocardial infarction; IMR = index of microcirculatory resistance; MI = myocardial infarction; NYHA = New York Heart Association; PCI = percutaneous coronary intervention.
Figure 3
Figure 3
Thromboelastography Measurement in the CMD Versus Non-CMD Groups CMD = coronary microvascular dysfunction; P-FCS = platelet-fibrin clot strength; other abbreviations as in Figure 1.
Figure 4
Figure 4
Association Between P-FCS and CMD Occurrence (A) Distribution of P-FCS and prevalence of CMD. (B) Receiver-operating characteristic curve analysis: the optimal cutoff of P-FCS for CMD. (C) Risk of high P-FCS for CMD occurrence. OR = odds ratio; other abbreviations as in Figures 1 and 3.
Figure 5
Figure 5
Kaplan-Meier Curves of 3-Year MACE (A) Groups divided by IMR. (B) Groups divided by CFR. (C) Groups divided by IMR and P-FCS. (D) Groups divided by CFR and P-FCS. CFR = coronary flow reserve; MACE = major adverse cardiovascular events; other abbreviations as in Figures 1 and 3.
See this image and copyright information in PMC

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