Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 2:9:1051174.
doi: 10.3389/fcvm.2022.1051174. eCollection 2022.

One-year results from the Assessing MICRO-vascular resistances via IMR to predict outcome in ST-elevation myocardial infarction patients with multivessel disease undergoing primary PCI (AMICRO) trial

Massimo Fineschi  1 , Edoardo Verna  2 , Alberto Barioli  3   4 , Giuseppe Mezzapelle  5 , Davide Bartolini  6 , Giovanni Turiano  7 , Vincenzo Guiducci  8 , Antonio Manari  8 , Katya Lucarelli  9 , Lucia Uguccioni  10 , Alessandra Repetto  11 , Giuseppe Tarantini  4
Affiliations

One-year results from the Assessing MICRO-vascular resistances via IMR to predict outcome in ST-elevation myocardial infarction patients with multivessel disease undergoing primary PCI (AMICRO) trial

Massimo Fineschi et al. Front Cardiovasc Med. .

Abstract

Background: In ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary angioplasty (PPCI) the index of microcirculatory resistance (IMR) correlates to the extent of myocardial damage and left ventricular (LV) function recovery. Data on the IMR time-course and impact on clinical outcome in STEMI patients with multi-vessel disease (MVD) are scarce.

Aims: We designed a prospective, multicenter clinical trial to assess the infarct-related artery (IRA)-IMR in STEMI patients with MVD undergoing PPCI and to explore its potential in relationship with outcome and LV remodeling.

Methods: The study enrolled 242 STEMI patients with MVD. Both fractional flow reserve (FFR) and IMR of the IRA were assessed after successful PPCI. Then, FFR/IMR measurements were repeated in the IRA at a staged angiography, and FFR-guided angioplasty was performed in non-IRA lesions. The primary endpoint was the composite of cardiovascular death, re-infarction, re-hospitalization for heart failure, resuscitation or appropriate ICD shock at 1-year follow-up.

Results: A significant improvement of IRA-IMR values (from 47.9 to 34.2, p < 0.0001) was observed early after PPCI. Staged FFR-guided angioplasty was performed in 102 non-IRA lesions. We failed to find a correlation between IRA-IMR, clinical events and LV remodeling. Notwithstanding, in patients with anterior STEMI an inverse correlation between initial IMR values and LV function at follow-up was observed.

Conclusion: After successful PPCI, a significant proportion of patients with STEMI and MVD had coronary microvascular dysfunction as assessed by IMR that recovered early after reperfusion. Higher IMR values predicted lack of improvement of LV function only in anterior STEMI.

Clinical trial registration: https://clinicaltrials.gov/, identifier [NCT02325973].

Keywords: STEMI; fractional flow reserve (FFR); microvascular resistance; multivessel disease (MVD); índex of microvascular resistance (IMR).

PubMed Disclaimer

Conflict of interest statement

Authors MF, EV, and GM report speaker honoraria from St. Jude Medical Italia (now Abbott). Authors MF and EV also report consulting fees for St. Jude Medical Italia (now Abbott). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of enrolled patients.
FIGURE 2
FIGURE 2
Index of microvascular resistance (IMR) time course from primary to staged procedure. Group A: patients who experienced primary endpoints. Group B: primary endpoints event-free patients. No significant differences in IMR values were observed between the two groups after successful PPCI of the culprit lesion. The IRA IMR significantly improved in event-free patients between PPCI and staged procedure. IMR, index of microvascular resistance; PPCI, primary percutaneous coronary intervention; IRA, infarct-related artery.
FIGURE 3
FIGURE 3
Index of microvascular resistance (IMR) after PPCI of the left anterior descending artery and left ventricular EF at hospital discharge and 12 months follow-up. Higher IMR measurements after PPCI predicted lack of improvement of LV function at follow-up in patients with anterior myocardial infarction. IMR, index of microvascular resistance; PPCI, primary percutaneous coronary intervention; EF, ejection fraction; LV, left ventricle.
See this image and copyright information in PMC

References

    1. Kawamoto T, Yoshida K, Akasaka T, Hozumi T, Takagi T, Kaji S, et al. Can coronary blood flow velocity pattern after primary percutaneous transluminal coronary angioplasty [correction of angiography] predict recovery of regional left ventricular function in patients with acute myocardial infarction? Circulation. (1999) 100:339–45. 10.1161/01.cir.100.4.339 - DOI - PubMed
    1. Gibson C, Cannon C, Murphy S, Ryan K, Mesley R, Marble S, et al. Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation. (2000) 101:125–30. 10.1161/01.cir.101.2.125 - DOI - PubMed
    1. Niccoli G, Burzotta F, Galiuto L, Crea F. Myocardial no-reflow in humans. J Am Coll Cardiol. (2009) 54:281–92. 10.1016/j.jacc.2009.03.054 - DOI - PubMed
    1. Nijveldt R, Beek A, Hirsch A, Stoel M, Hofman M, Umans V, et al. Functional recovery after acute myocardial infarction: comparison between angiography, electrocardiography, and cardiovascular magnetic resonance measures of microvascular injury. J Am Coll Cardiol. (2008) 52:181–9. 10.1016/j.jacc.2008.04.006 - DOI - PubMed
    1. Ndrepepa G, Tiroch K, Fusaro M, Keta D, Seyfarth M, Byrne R, et al. 5-year prognostic value of no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction. J Am Coll Cardiol. (2010) 55:2383–9. 10.1016/j.jacc.2009.12.054 - DOI - PubMed

Associated data