Angiography-Derived Index of Microcirculatory Resistance to Define the Risk of Early Discharge in STEMI.
Citation: Circulation: Cardiovascular Interventions. 17(3):e013556, 2024 03.PMID: 38375667Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *Heart Failure | *Myocardial Infarction | *Percutaneous Coronary Intervention | *ST Elevation Myocardial Infarction | Coronary Angiography | Coronary Vessels/dg [Diagnostic Imaging] | Heart Failure/et [Etiology] | Humans | Microcirculation | Myocardial Infarction/dg [Diagnostic Imaging] | Myocardial Infarction/et [Etiology] | Myocardial Infarction/th [Therapy] | Observational Studies as Topic | Patient Discharge | Percutaneous Coronary Intervention/ae [Adverse Effects] | Prospective Studies | Retrospective Studies | ST Elevation Myocardial Infarction/dg [Diagnostic Imaging] | ST Elevation Myocardial Infarction/et [Etiology] | ST Elevation Myocardial Infarction/th [Therapy] | Treatment Outcome | Year: 2024Local holdings: Available online from MWHC library: 2008 - presentISSN:- 1941-7640
- Garcia Garcia, Hector M:
- https://orcid.org/0000-0001-5100-0471
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
---|---|---|---|---|---|---|
Journal Article | MedStar Authors Catalog | Article | 38375667 | Available | 38375667 |
Available online from MWHC library: 2008 - present
BACKGROUND: Patients with ST-segment-elevation myocardial infarction but no coronary microvascular injury are at low risk of early cardiovascular complications (ECC). We aim to assess whether nonhyperemic angiography-derived index of microcirculatory resistance (NH-IMRangio) could be a user-friendly tool to identify patients at low risk of ECC, potentially candidates for expedited care pathway and early hospital discharge.
CONCLUSIONS: NH-IMRangio is a valuable risk-stratification tool in patients with ST-segment-elevation myocardial infarction. NH-IMRangio guided strategies to early discharge may contribute to safely shorten hospital stay, optimizing resources utilization.
METHODS: Retrospective analysis of 2 independent, international, prospective, observational cohorts included 568 patients with ST-segment-elevation myocardial infarction. NH-IMRangio was calculated based on standard coronary angiographic views with 3-dimensional-modeling and computational analysis of the coronary flow.
RESULTS: Overall, ECC (a composite of cardiovascular death, cardiogenic shock, acute heart failure, life-threatening arrhythmias, resuscitated cardiac arrest, left ventricular thrombus, post-ST-segment-elevation myocardial infarction mechanical complications, and rehospitalization for acute heart failure or acute myocardial infarction at 30 days follow-up), occurred in 54 (9.3%) patients. NH-IMRangio was significantly correlated with pressure/thermodilution-based index of microcirculatory resistance (r=0.607; P<0.0001) and demonstrated good accuracy in predicting ECC (area under the curve, 0.766 [95% CI, 0.706-0.827]; P<0.0001). Importantly, ECC occurred more frequently in patients with NH-IMRangio >=40 units (18.1% versus 1.4%; P<0.0001). At multivariable analysis, NH-IMRangio provided incremental prognostic value to conventional clinical, angiographic, and echocardiographic features (adjusted-odds ratio, 14.861 [95% CI, 5.177-42.661]; P<0.0001). NH-IMRangio<40 units showed an excellent negative predictive value (98.6%) in ruling out ECC. Discharging patients with NH-IMRangio<40 units at 48 hours after admission would reduce the total in-hospital stay by 943 days (median 2 [1-4] days per patient).
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