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Periprocedural myocardial infarction (PPMI) defined by the Third Universal Definition of Myocardial Infarction occurs in a significant proportion of patients undergoing elective coronary intervention (PCI) and has been reported to show poor outcomes. Recent studies suggested that the index of microcirculatory resistance (IMR) prospectively identifies patients at high risk of PPMI. We hypothesized that not IMR but fractional flow reserve (FFR) may predict PPMI related to elective PCI.
Methods and Results
FFR and IMR were measured in 80 patients before elective PCI in a culprit vessel with a PressureWire. Median post-PCI cardiac troponin I (cTnl) was 0.29 (interquartile range 0.11 to 0.85) ng/ml, and 16 of 80 (20%) patients fulfilled the criteria for PPMI (peak post-PCI cTnl > 5 times the 99 percentile:1.0ng/mL). There was no significant difference in pre-PCI IMR between PPMI group and non-PPMI group. From binary logistic regression analyses of all clinical, procedural, and physiological parameters, univariable predictors of PPMI were pre-PCI FFR (P=0.02), the stented length (P=0.04), and stent diameter (P=0.05). Multiple regression analysis revealed that pre-PCI FFR (odds ratio [OR] 0.008, 95% confidence interval [CI] 0.000-0.765, p = 0.04) and stented length (OR 1.059, 95% CI 1.004-1.116, p = 0.04) were independent predictors of PPMI. FFR less than 0.64 had a sensitivity of 56.2% and a specificity of 81.2% for predicting PPMI.
These data suggest that not the status of the coronary microcirculation represented by IMR but the severity of functional stenosis may predict the susceptibility of PPMI defined by the current definition of periprocedural myocardial infarction in patients treated with elective PCI.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: New Tests, Targets and Treatments in SIHD
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1240-67
- 2013 American College of Cardiology Foundation