Fractional flow reserve for the assessment of nonculprit coronary artery stenoses in patients with acute myocardial infarction.

Abstract

OBJECTIVES:

We investigated the reliability of fractional flow reserve (FFR) of nonculprit coronary stenoses during percutaneous coronary intervention (PCI) in acute myocardial infarction.

BACKGROUND:

Assessing the hemodynamic severity of the nonculprit coronary artery stenoses at the acute phase of a myocardial infarction could improve risk stratification and shorten the diagnostic work-up.

METHODS:

One hundred one patients undergoing PCI for an acute myocardial infarction (n = 75 with ST-segment elevation myocardial infarction [STEMI], and n = 26 with non-ST-segment elevation myocardial infarction) were prospectively recruited. The FFR measurements in 112 nonculprit stenoses were obtained immediately after PCI of the culprit stenosis and were repeated 35 ± 4 days later. In addition, left ventricular ejection fraction, quantitative coronary angiographic measurements of the nonculprit stenoses, Thrombolysis In Myocardial Infarction (TIMI) flow, corrected TIMI frame count (cTFC), and the index of microcirculatory resistance (n = 14) of the nonculprit vessels were assessed in the acute phase and at control angiogram.

RESULTS:

The FFR value of the nonculprit stenoses did not change between the acute and follow-up (0.77 ± 0.13 vs. 0.77 ± 0.13, respectively, p = NS). In only 2 patients, the FFR value was higher than 0.8 at the acute phase and lower than 0.75 at follow-up. The TIMI flow, cTFC, percentage diameter stenosis, minimum lumen diameter, and index of microcirculatory resistance did not change. Left ventricular ejection fraction increased significantly in patients with STEMI (from 54 ± 13% to 57 ± 13%, p = 0.03).

CONCLUSIONS:

During the acute phase of acute coronary syndromes, the severity of nonculprit coronary artery stenoses can reliably be assessed by FFR. This allows a decision about the need for additional revascularization and might contribute to a better risk stratification.

• Authors: Argyrios Ntalianis, Jan-Willem Sels, Giedrius Davidavicius, Nobuhiro Tanaka, Olivier Muller, Catalina Trana, Emanuele Barbato, Michalis Hamilos, Fabio Mangiacapra, Guy R Heyndrickx, William Wijns, Nico H J Pijls, Bernard De Bruyne
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 3 Issue 12 Pg. 1274-81 (Dec 2010) ISSN: 1876-7605 [Electronic] United States
• PMID: 21232721 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Validation Study)
• Copyright: Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Angioplasty, Balloon, Coronary
• Coronary Angiography
• Coronary Stenosis (diagnosis, pathology)
• Coronary Vessels (pathology)
• Female
• Fractional Flow Reserve, Myocardial
• Health Status Indicators
• Hemodynamics
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, pathology, therapy)
• Prospective Studies
• Reproducibility of Results
• Statistics, Nonparametric
• Stroke Volume
• Ventricular Function, Left