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Clinical and Angiographic Predictors of Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction

이만종|신성희|김대혁|박금수|권준|우성일|박상돈|김수한|백용수
연세대학교의과대학 (Yonsei University College of Medicine)|2015.09|Yonsei Medical Journal|제56권 제5호|pp. 1235-1243|DOI 10.3349/ymj.2015.56.5.1235

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참고문헌

키워드

ST-segment elevation myocardial infarctionMicrovascular dysfunctionindex of microcirculatory resistancedoor- to-balloon timesymptom-onset-to-balloon time
주제분류의학일반

초록

Purpose: We aimed to discover clinical and angiographic predictors of microvascular dysfunction using the index of microcirculatoryresistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI). Materials and Methods: We enrolled 113 patients with STEMI (age, 56±11 years; 95 men) who underwent primary percutaneous coronary intervention (PCI). The IMR was measured with a pressure sensor/thermistor-tipped guidewire after primary PCI. The patients were divided into three groups based on IMR values: Low IMR [<18 U (12.9±2.6 U), n=38], Mid IMR [18–31 U (23.9±4.0 U), n=38], and High IMR [>31 U (48.1±17.1 U), n=37]. Results: The age of the Low IMR group was significantly lower than that of the Mid and High IMR groups. The door-to-balloon time was <90 minutes in all patients, and it was not significantly different between groups. Meanwhile, the symptom-onset-to-balloon time was significantly longer in the High IMR group, compared to the Mid and Low IMR groups (p<0.001). In the high IMR group, the culprit lesion was found in a proximal location significantly more often than in a non-proximal location (p=0.008). In multivariate regression analysis, age and symptom-onset-to-balloon time were independent determinants of a high IMR (p=0.013 and p=0.003, respectively). Conclusion: Our data suggest that age and symptom-onset-to-balloon time might be the major predictors of microvascular dysfunctionin STEMI patients with a door-to-balloon time of <90 minutes.

Abstract

Purpose: We aimed to discover clinical and angiographic predictors of microvascular dysfunction using the index of microcirculatoryresistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI). Materials and Methods: We enrolled 113 patients with STEMI (age, 56±11 years; 95 men) who underwent primary percutaneous coronary intervention (PCI). The IMR was measured with a pressure sensor/thermistor-tipped guidewire after primary PCI. The patients were divided into three groups based on IMR values: Low IMR [<18 U (12.9±2.6 U), n=38], Mid IMR [18–31 U (23.9±4.0 U), n=38], and High IMR [>31 U (48.1±17.1 U), n=37]. Results: The age of the Low IMR group was significantly lower than that of the Mid and High IMR groups. The door-to-balloon time was <90 minutes in all patients, and it was not significantly different between groups. Meanwhile, the symptom-onset-to-balloon time was significantly longer in the High IMR group, compared to the Mid and Low IMR groups (p<0.001). In the high IMR group, the culprit lesion was found in a proximal location significantly more often than in a non-proximal location (p=0.008). In multivariate regression analysis, age and symptom-onset-to-balloon time were independent determinants of a high IMR (p=0.013 and p=0.003, respectively). Conclusion: Our data suggest that age and symptom-onset-to-balloon time might be the major predictors of microvascular dysfunctionin STEMI patients with a door-to-balloon time of <90 minutes.

참고문헌 (41)

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