The impact of primary percutaneous coronary intervention strategies during ST-elevation myocardial infarction on the prevalence of coronary microvascular dysfunction

• Published in: Scientific reports Vol. 13; no. 1; p. 20094
• Main Authors: Aldujeli, Ali, Haq, Ayman, Tsai, Tsung-Ying, Grabauskyte, Ingrida, Tatarunas, Vacis, Briedis, Kasparas, Rana, Sumit, Unikas, Ramunas, Hamadeh, Anas, Serruys, Patrick W., Brilakis, Emmanouil S.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 16-11-2023; Nature Publishing Group; Nature Portfolio
• Subjects: 692/4019; 692/4019/2776; Aged; Angioplasty; Balloon treatment; Clinical trials; Female; Fractional Flow Reserve, Myocardial; Glycoproteins; Heart attacks; Humanities and Social Sciences; Humans; Inhibitors; Lesions; Male; Microcirculation; Microvasculature; multidisciplinary; Myocardial infarction; NCT; NCT05406297; Percutaneous Coronary Intervention - adverse effects; Prevalence; Prospective Studies; Science; Science (multidisciplinary); ST Elevation Myocardial Infarction - etiology; ST Elevation Myocardial Infarction - surgery; Treatment Outcome
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-023-47343-x

Coronary microvascular dysfunction (CMD) is a common complication of ST-segment elevation myocardial infarction (STEMI) and can lead to adverse cardiovascular events. This is a non-randomized, observational, prospective study of STEMI patients with multivessel disease who underwent primary PCI, grouped based on whether they underwent balloon pre-dilatation stenting or direct stenting of the culprit lesion. Coronary physiology measurements were performed 3 months post-PCI including coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) measurements at the culprit vessel. The primary endpoint was the prevalence of CMD at 3 months, defined as IMR ≥ 25 or CFR < 2.0 with a normal fractional flow reserve. Secondary endpoints included major adverse cardiovascular events (MACE) at 12 months. Two hundred ten patients were enrolled; most were men, 125 (59.5%), with a median age of 65 years. One hundred twelve (53.2%) underwent balloon pre-dilatation before stenting, and 98 (46.7%) underwent direct stenting. The prevalence of CMD at 3 months was lower in the direct stenting group than in the balloon pre-dilatation stenting group (12.24% vs. 40.18%;
p
 < 0.001). Aspiration thrombectomy and administration of intracoronary glycoprotein IIb/IIIa inhibitors were associated with lower odds of CMD (OR = 0.175,
p
 = 0.001 and OR = 0.113,
p
 = 0.001, respectively). Notably, MACE in patients who underwent direct stenting was lower than in those who underwent balloon pre-dilatation before stenting (14.29% vs. 26.79%;
p
 = 0.040). In STEMI patients with multivessel disease, direct stenting of the culprit lesion, aspiration thrombectomy and administration of intracoronary glycoprotein IIb/IIIa inhibitors were associated with a lower prevalence of CMD at 3 months and lower incidence of MACE at 12 months compared with balloon pre-dilatation stenting.
This trial is registered at
https://ichgcp.net/clinical-trials-registry/NCT05406297
.