指数事件后非st段抬高型心肌梗死的微循环功能及随访评价

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-06-01 DOI:10.1016/j.cjco.2025.04.005

Luis Paiva MD , Enrique Gutiérrez MD , Maria João Ferreira MD, PhD , Lino Gonçalves MD, PhD

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引用次数: 0

摘要

背景：非st段抬高型心肌梗死（NSTEMI）很少考虑冠状动脉生理学的评估。本研究旨在表征NSTEMI急性期心肌梗死（MI）罪魁祸首冠状动脉的冠状动脉生理学特征，确定其微血管功能障碍的发生率及随后的随访评估。方法本研究纳入30例住院NSTEMI患者。采用血流储备分数、冠状动脉血流储备（CFR）和微循环阻力指数（IMR）对心肌梗死罪魁祸首冠状动脉进行生理评估。在心肌梗死后中位7个月，患者对同一冠状动脉进行重复的生理评估。结果使用CFR (<；2.0)在NSTEMI急性期经常出现（60%），而严重的微循环功能障碍(IMR >；40)不常见（17%）。随着时间的推移，异常CFR值的发生率显著降低(<；2.0;60% vs 26%, P = 0.013)和广泛微血管阻力(IMR >；40;17% vs 4%, P = 0.03)。根据CFR和IMR结果对患者进行分类。CFR异常患者(<；2.0)和正常IMR (<；25)， CFR的降低是由于静息冠状动脉血流量的增加而不是充血流量的减少。结论NSTEMI急性期，心肌梗死罪魁祸首冠状动脉CFR普遍降低，严重微循环功能障碍少见。

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Microcirculation Function in Non-ST-Elevation Myocardial Infarction After the Index Event and at Follow-Up Assessment

Background

The assessment of coronary physiology is seldom considered in cases of non-ST-elevation myocardial infarction (NSTEMI). This study aimed to characterize coronary physiology and determine the incidence of microvascular dysfunction in the myocardial infarction (MI) culprit coronary artery during the acute phase of NSTEMI and subsequent follow-up evaluation.

Methods

This study included 30 patients hospitalized for NSTEMI. A physiological assessment of the MI culprit coronary artery was performed using fractional flow reserve, coronary flow reserve (CFR), and index of microcirculatory resistance (IMR). At a median of 7 months after MI, patients underwent repeated physiological assessment of the same coronary artery.

Results

Microvascular dysfunction identified using CFR (< 2.0) was frequently present (60%) during the acute phase of NSTEMI, whereas severe microcirculatory dysfunction (IMR > 40) was uncommon (17%). Over time, a significant reduction occurred in the prevalence of abnormal CFR values (< 2.0; 60% vs 26%, P = 0.013) and extensive microvascular resistance (IMR > 40; 17% vs 4%, P = 0.03) at the follow-up evaluation. Patients were categorized according to their CFR and IMR results. In patients with abnormal CFR (< 2.0) and normal IMR (< 25), reduced CFR is attributable to elevated resting coronary blood flow rather than diminished hyperemic flow.

Conclusions

In the acute phase of NSTEMI, reduced CFR was commonly observed in the MI culprit coronary artery, whereas severe microcirculatory dysfunction was infrequent.

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