Korean Circ J.  2015 May;45(3):194-201. 10.4070/kcj.2015.45.3.194.

Usefulness of Hyperemic Microvascular Resistance Index as a Predictor of Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction

• Jin X
• Yoon MH
• Seo KW
• Tahk SJ
• Lim HS
• Yang HM
• Choi BJ
• Choi SY
• Hwang GS
• Shin JH
• Park JS

• KMID: 2389126
• DOI: http://doi.org/10.4070/kcj.2015.45.3.194

Abstract

BACKGROUND AND OBJECTIVES
Microvascular function is a useful predictor of left ventricular functional changes in patients with ST-segment elevation myocardial infarction (STEMI). We evaluated the usefulness of the hyperemic microvascular resistance index (hMVRI) for predicting long-term major adverse cardiovascular events (MACEs) in patients with STEMI assessed immediately after primary percutaneous coronary intervention (PCI).
SUBJECTS AND METHODS
hMVRI were evaluated in 145 patients with first acute STEMI treated with primary PCI using an intracoronary Doppler wire. hMVRI was defined as the ratio of mean aortic pressure over hyperemic averaged peak velocity of infarct-related artery. Major adverse cardiovascular events (MACEs) included cardiac death and re-hospitalization for congestive heart failure.
RESULTS
During the mean follow-up of 85+/-43 months, MACEs occurred in 17.2% of patients. Using a receiver-operating characteristics analysis, hMVRI >2.82 mm Hg.cm-1.sec (sensitivity: 87%; specificity: 69%; and area under curve: 0.818) was the best cut-off values for predicting future cardiac events. The Cox proportional hazard analysis showed that hMVRI was an independent predictor for long-term MACEs (hazard ratio 1.741, 95% confidence interval 1.348-2.264, p<0.001). The Kaplan-Meier survival analysis showed a higher incidence of MACEs in patients with hMVRI >2.82 mm Hg.cm-1.sec (p<0.001).
CONCLUSION
hMVRI was a strong predictor of long-term MACEs in patients with STEMI treated with primary PCI.

Keyword

Myocardial infarction; Microcirculation; Percutaneous coronary intervention

MeSH Terms

Area Under Curve
Arterial Pressure
Arteries
Death
Follow-Up Studies
Heart Failure
Humans
Incidence
Microcirculation
Myocardial Infarction*
Percutaneous Coronary Intervention
Sensitivity and Specificity

Figure

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  Fig. 1 Comparison of hMVRI in patients with and without MACEs. hMVRI: hyperemic microvascular resistance index, MACE: major adverse cardiovascular event.

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  Fig. 2 Receiver-operating characteristic curve showing the optimal cut-off value of hMVRI for predicting long-term MACEs. BCV: best cut-off value, hMVRI: hyperemic microvascular resistance index.

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  Fig. 3 The Kaplan-Meier curves using the cut-off value of hMVRI for MACEs. hMVRI: hyperemic microvascular resistance index, MACE: major adverse cardiovascular event.

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