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. 2024 May 3:S0735-1097(24)06759-7.
doi: 10.1016/j.jacc.2024.02.052. Online ahead of print.

Prognostic Value of Microvascular Resistance Reserve After Percutaneous Coronary Intervention in Patients With Myocardial Infarction

Rob Eerdekens  1 , Mohamed El Farissi  1 , Giovanni Luigi De Maria  2 , Niels van Royen  3 , Marcel van 't Veer  1 , Maarten A H van Leeuwen  4 , Stephen P Hoole  5 , Federico Marin  2 , David Carrick  6 , Pim A L Tonino  1 , Nico H J Pijls  1 , Massimo Fineschi  7 , Keith G Oldroyd  8 , Colin Berry  9 , Adrian P Banning  2 , William F Fearon  10 , Frederik M Zimmermann  11
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Free article

Prognostic Value of Microvascular Resistance Reserve After Percutaneous Coronary Intervention in Patients With Myocardial Infarction

Rob Eerdekens et al. J Am Coll Cardiol. .
Free article

Abstract

Background: The microvascular resistance reserve (MRR) has recently been introduced as a novel index to assess the vasodilatory capacity of the microcirculation, independent of epicardial disease. The prognostic value of MRR in ST-segment elevation myocardial infarction (STEMI) is unknown.

Objectives: The aim of this analysis was to investigate the prognostic value of MRR in patients with STEMI and to compare MRR with cardiovascular magnetic resonance imaging parameters.

Methods: From a pooled analysis of individual patient data from 6 cohorts that measured the index of microcirculatory resistance (IMR) directly after primary percutaneous coronary intervention in patients with STEMI (n = 1,265), a subgroup analysis was performed in patients in whom both MRR and IMR were available. The primary endpoint was the composite of all-cause mortality or hospitalization for heart failure.

Results: Both MRR and IMR could be calculated in 446 patients. The optimal cutoff of MRR to predict the primary endpoint in this STEMI population was 1.25. During a median follow-up of 3.1 years (Q1-Q3: 1.5-6.1 years), the composite of all-cause mortality or hospitalization for heart failure occurred in 27.3% and 5.9% of patients (HR: 4.16; 95% CI: 2.31-7.50; P < 0.001) in the low MRR (≤1.25) and high MRR (>1.25) groups, respectively. Both IMR and MRR were independent predictors of the composite of all-cause mortality or hospitalization for heart failure.

Conclusions: MRR measured directly after primary percutaneous coronary intervention was an independent predictor of the composite of all-cause mortality or hospitalization for heart failure during long-term follow-up.

Keywords: IMR; MRR; STEMI; microcirculation; prognosis.

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Conflict of interest statement

Funding Support and Author Disclosures Dr De Maria has received consultancy fees from Miracor Medical SA and Corflow; and has received grants from Abbott, Philips, Medtronic, Terumo, Miracor Medical SA, and Opsens. Dr van Royen has received research grants from Philips, Abbott, Medtronic, and Biotronik; and has received speaker fees from Abbott, Bayer, Rainmed, and Microport. Dr van Leeuwen has received speakers/consulting services honoraria from Terumo, Daiichi-Sankyo, and Abbott; and has received research grants from AstraZeneca, Top Sector Life Sciences & Health, Terumo, Top Medical B.V., and Abbott. Dr Pijls has received institutional research grants from Abbott and Hexacath; is a consultant for Abbott and Opsens; holds minor equity interest in Philips, ASML, HeartFlow, and GE; is a member of the scientific advisory board for HeartFlow; and has patents pending on diagnostic methods for quantifying aortic valve stenosis and microvascular physiology. Dr Fineschi has received speaker honoraria and consulting fees from St Jude Medical Italia (now Abbott). Dr Oldroyd has received honoraria from Abbott, Biosensors International, and Boston Scientific; has received an institutional research grant from Boston Scientific that supported the present manuscript; and has been a full-time employee of Biosensors International since May 2020. Dr Berry has received institutional grants/contracts from Abbott, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, HeartFlow, Novartis, Siemens Healthcare; has received consulting fees from Abbott, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, HeartFlow, Menarini, and Novartis; and has received honoraria from Abbott, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, HeartFlow, Philips, and Valo Health. Dr Fearon has received research support from Abbott, Boston, Edwards, and Medtronic; has consulting agreements with CathWorks and Siemens; and has equity options with HeartFlow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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