PT  - JOURNAL ARTICLE
AU  - de Waard, Guus A
AU  - Fahrni, Gregor
AU  - de Wit, Douwe
AU  - Kitabata, Hironori
AU  - Williams, Rupert
AU  - Patel, Niket
AU  - Teunissen, Paul F
AU  - van de Ven, Peter M
AU  - Umman, Sabahattin
AU  - Knaapen, Paul
AU  - Perera, Divaka
AU  - Akasaka, Takashi
AU  - Sezer, Murat
AU  - Kharbanda, Rajesh K
AU  - van Royen, Niels
ED - 
TI  - Hyperaemic microvascular resistance predicts clinical outcome and microvascular injury after myocardial infarction
AID  - 10.1136/heartjnl-2017-311431
DP  - 2018 Jan 01
TA  - Heart
PG  - 127--134
VI  - 104
IP  - 2
4099  - http://heart.bmj.com/content/104/2/127.short
4100  - http://heart.bmj.com/content/104/2/127.full
SO  - Heart2018 Jan 01; 104
AB  - Objectives Early detection of microvascular dysfunction after acute myocardial infarction (AMI) could identify patients at high risk of adverse clinical outcome, who may benefit from adjunctive treatment. Our objective was to compare invasively measured coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) for their predictive power of long-term clinical outcome and cardiac magnetic resonance (CMR)-defined microvascular injury (MVI).Methods Simultaneous intracoronary Doppler flow velocity and pressure measurements acquired immediately after revascularisation for AMI from five centres were pooled. Clinical follow-up was completed for 176 patients (mean age 60±10 years; 140(80%) male; ST-elevation myocardial infarction (STEMI) 130(74%) and non-ST-segment elevation myocardial infarction 46(26%)) with median follow-up time of 3.2 years. In 110 patients with STEMI, additional CMR was performed.Results The composite end point of death and hospitalisation for heart failure occurred in 17 patients (10%). Optimal cut-off values to predict the composite end point were 1.5 for CFR and 3.0 mm Hg cm−1•s for HMR. CFR <1.5 was predictive for the composite end point (HR 3.5;95% CI 1.1 to 10.8), but not for its individual components. HMR ≥3.0 mm Hg cm−1 s was predictive for the composite end point (HR 7.0;95% CI 1.5 to 33.7) as well as both individual components. HMR had significantly greater area under the receiver operating characteristic curve for MVI than CFR. HMR remained an independent predictor of adverse clinical outcome and MVI, whereas CFR did not.Conclusions HMR measured immediately following percutaneous coronary intervention for AMI with a cut-off value of 3.0 mm Hg cm−1 s, identifies patients with MVI who are at high risk of adverse clinical outcome. For this purpose, HMR is superior to CFR.