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Clinical Trial
. 2023 May:147:104495.
doi: 10.1016/j.mvr.2023.104495. Epub 2023 Feb 3.

Coronary microcirculation in nonculprit vessel territory in reperfused acute myocardial infarction

Murat Sezer  1 , Ahmet Tas  2 , Zeynep G Demirtakan  2 , Christopher J Broyd  3 , Alp Ozcan  2 , Hakan Hasdemir  4 , Mehmet Kocaaga  2 , Irem Sezer  4 , Mehmet R Sonsoz  2 , Adem Atici  2 , Ilke Ozcan  2 , Berrin Umman  2 , Zehra Bugra  2 , Justin E Davies  5 , Javier Escaned  6 , Niels van Royen  7 , Sabahattin Umman  2
Affiliations
Clinical Trial

Coronary microcirculation in nonculprit vessel territory in reperfused acute myocardial infarction

Murat Sezer et al. Microvasc Res. 2023 May.

Abstract

Background: There is an ongoing debate on the extension of reperfusion-related microvascular damage (MVD) throughout the remote noninfarcted myocardial regions in patients with ST-elevation myocardial infarction (STEMI) that undergo primary percutaneous intervention (pPCI). The aim of this study was to elucidate the impact of reperfusion on remote microcirculatory territory by analyzing hemodynamic alterations in the nonculprit-vessel in relation to reperfusion.

Methods: A total of 20 patients with STEMI undergoing pPCI were included. Peri-reperfusion temporal changes in hemodynamic parameters were obtained in angiographically normal nonculprit vessels before and 1-h after reopening of the culprit vessel. Intracoronary pressure and flow velocity data were compared using pairwise analyses (before and 1-h after reperfusion).

Results: In the non-culprit vessel, compared to the pre-reperfusion state, mean resting average peak velocity (33.4 ± 9.4 to 25.0 ± 4.9 cm/s, P < 0.001) and mean hyperemic average peak velocity (53.5 ± 14.4 to 42.1 ± 10.66 cm/s, P = 0.001) significantly decreased; whereas baseline (3.2 ± 1.0 to 4.0 ± 1.0 mmHg.cm-1.s, P < 0.001) and hyperemic microvascular resistance (HMR) (1.9 ± 0.6 to 2.4 ± 0.7 mmHg.cm-1.s, P < 0.001) and mean zero flow pressure (Pzf) values (32.5 ± 6.9 to 37.6 ± 8.3 mmHg, P = 0.003) significantly increased 1-h after reperfusion. In particular, the magnitude of changes in HMR and Pzf values following reperfusion were more prominent in patients with larger infarct size and with higher extent of MVD in the culprit vessel territory.

Conclusion: Reperfusion-related microvascular injury extends to involve remote myocardial territory in relation to the magnitude of the adjacent infarction and infarct-zone MVD. (GUARD Clinical TrialsNCT02732080).

Keywords: Coronary hemodynamics; Microvascular damage; Microvascular resistance; Nonculprit-vessel; Primary PCI; Reperfusion injury; STEMI.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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