Coronary vasomotor function in infarcted and remote myocardium after primary percutaneous coronary intervention

• Published in: Heart (British Cardiac Society) Vol. 101; no. 19; pp. 1577 - 1583
• Main Authors: Teunissen, Paul F A, Timmer, Stefan A J, Danad, Ibrahim, de Waard, Guus A, van de Ven, Peter M, Raijmakers, Pieter G, Lammertsma, Adriaan A, Van Rossum, Albert C, van Royen, Niels, Knaapen, Paul
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.10.2015
• Subjects: Acute coronary syndromes; Adenosine; Adult; Aged; Cardiovascular disease; Case-Control Studies; Colonies & territories; Coronary vessels; Coronary Vessels - innervation; Female; Fractional Flow Reserve, Myocardial; Heart attacks; Humans; Male; Medical imaging; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardial Perfusion Imaging - methods; Oxygen Radioisotopes; Percutaneous Coronary Intervention; Positron-Emission Tomography; Predictive Value of Tests; Radiopharmaceuticals; Recovery of Function; Respiration; Studies; Time Factors; Treatment Outcome; Vascular Resistance; Vasodilation; Vasomotor System - physiopathology
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/heartjnl-2015-307825

ObjectiveIn patients with acute myocardial infarction (AMI), coronary vasomotor function is impaired in the myocardial territory supplied by the culprit artery and in remote myocardium supplied by angiographically normal vessels. The aim was to investigate the temporal evolution of coronary vasodilatory reserve in patients with AMI by use of [15O]H2O positron emission tomography, after successful percutaneous coronary intervention.Methods44 patients with AMI and successful revascularisation by percutaneous coronary intervention were included. Subjects were examined 1 week and 3 months after AMI with [15O]H2O positron emission tomography to assess the coronary flow reserve (CFR). CFR was defined as the ratio of myocardial blood flow (MBF) during hyperaemia and rest. Additionally, 45 age-matched and sex-matched subjects underwent similar scanning procedures and served as controls.ResultsAt baseline, CFR averaged 1.81±0.66 in infarcted myocardium versus 2.51±0.81 in remote myocardium (p<0.01). In comparison, CFR in the control group averaged 4.16±1.45 (p=0.001 vs both). During follow-up, the CFR increased to 2.74±0.85 in infarcted myocardium (p<0.01), and to 2.85±0.70 in remote myocardium (p<0.01). This was predominantly due to an increase in hyperaemic MBF, from 1.62±0.54 mL/min/g to 2.19±0.68 mL/min/g in infarcted myocardium (p<0.001), and 2.17±0.54 mL/min/g to 2.60±0.65 mL/min/g in remote myocardium (p<0.001).ConclusionsCFR in infarcted and remote myocardium is impaired 1 week after AMI. After 3 months vasomotor function partially recovers. However, as compared with control patients, MBF remains impaired in culprit and reference territories in patients with AMI.Clinical trial registrationNTR3164.