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Microcirculatory changes 24 hours after PCI linked to myocardial salvage
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Changes in invasive measures of microvascular function at 24 hours after primary PCI in patients with STEMI may be predictive of myocardial recovery, although not immediately after the procedure, study results showed.
Researchers evaluated 44 patients with STEMI who underwent PCI to assess coronary flow reserve (CFR) and index of myocardial resistance (IMR) immediately on completion of primary PCI and again 1 day later.
Researchers also evaluated ejection fraction, edema, late gadolinium enhancement and salvage at 24 hours and at 6 months after primary PCI using cardiac magnetic resonance.
Researchers found no difference in IMR or CFR measured immediately after primary PCI in patients with depressed ejection fraction compared with those with preserved ejection fraction. However, after 24 hours, CFR was significantly lower in those with depressed ejection fraction (2 vs. 2.6; P=.008).
Multivariate analysis revealed higher CFR after primary PCI (+8.9 per 1 CFR unit; P=.03) and greater increase in CFR between completion of primary PCI and day 1 (+8.5 per 1 CFR unit; P=.01) yielded a higher salvage index.
“Systemic endothelin levels were significantly different between groups with low and high ejection fraction, with a different time course and more significant elevation for a longer duration in the group with lower ejection fraction,” the researchers wrote. “Furthermore, endothelin correlated with CFR at 24 hours but not immediately after primary PCI. These findings imply that measurement of microvascular function may change within individuals after infarction and that recovery of CFR over the first 24 hours after primary PCI is associated with better myocardial outcomes.”
Disclosure: The researchers report no relevant financial disclosures.
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