Author + information
- Felipe Diez-Delhoyo1,
- Enrique Gutiérrez2,
- Ricardo Sanz-Ruiz3,
- Fernando Sarnago Cebada4,
- Allan Rivera3,
- Hugo Gonzalez Saldivar3,
- Jaime Elizaga3 and
- Francisco Fernandez-Aviles5
- 1Hospital General Universitario Gregorio Marañón, Madrid, Spain
- 2Hospital Universitario Gregorio Marañón, Madrid, Madrid, Spain
- 3Instituto de Investigación Sanitaria Gregorio Marañon. CIBER CV, Madrid, Spain
- 4Gregorio Marañon, Madrid, Spain
- 5Instituto de Investigación Sanitaria Gregorio Marañon. CIBER CV. Universidad Complutense, Madrid, Spain
Approximately half of the patients presenting with acute myocardial infarction (AMI) have multivessel disease. The physiology of the non-culprit artery (NCA) it’s not well defined.
The FISIOIAM is an ongoing observational single-center study including patients with AMI and multivessel disease (NCA with a severity between 30-85%). Epicardial endothelial function was assessed using intracoronary acetylcholine (ACH); epicardial severity quantification was based on fractional flow reserve (FFR); microvascular dysfunction was evaluated by calculating the coronary flow reserve (CFR) and index of microvasuclar resistance (IMR); microvascular endothelial function was assessed with a modified CFR after ACH infusion. Decision to perform percutaneous coronary intervention (PCI) was based of FFR and physicians’ discretion.
We present in-hospital results of the first 55patients included so far since July/16. Table 1 resumes the main variables. The mean severity of the NCA, assessed by QCA, was 62,7±12%, with a mean length of 13,2±9mm. Epicardial endothelial dysfunction, defined as coronary spasm>50%, was observed in 53,8% of the patients, with 85,7% of them taking place in the NCA (in 40% exclusively over the non-culprit plaque); an FFR<0,8 was present in 35,2% of subjects, despite 41% underwent PCI due to physicians‘ discretion; microvascular non-endothelial dependent dysfunction, established as CFR<2 and IMR>25, was observed in 39% and 29,6% respectively; finally, microvascular endothelial-dependent dysfunction, defined as an ACH-CFR<1.5, was present in 48% of patients. No procedure-related complications were observed.
|Diabetes||14,5%||Previous Ischemic Heart Disease||5,5%|
|Active Smoker||43,6%||ST-segment myocardial infarction||85,5%|
|GRACE score||110,9±25||Killip I||94,5%|
|Culprit Artery||RCA 56,4%; LAD 27,3%||NCA||LAD 41,8%; CX 36,4%|
A complete functional assessment of the NCA in the context of AMI is a feasible and safe procedure. Endothelial dysfunction, both macro and microvascular, is a common finding, affecting 50% of the subjects. In a significant proportion of them, it’s driven by NCA plaque-related spasm. Microvascular dysfunction is observed in a third of patients. FFR-driven revascularization permits the identification of 60-70% of hemodynamically non-significant lesions, avoiding over-stenting and saving costs.
IMAGING: FFR and Physiologic Lesion Assessment