After primary PCI was completed, intracoronary nitroglycerin (100-200 μg) was administered and a coronary pressure wire (St. Jude Medical) was calibrated, equalized to the guide catheter Background-Most methods for assessing microvascular function are not readily available in the cardiac catheterization laboratory. The aim of this study is to determine whether the Index of Microcirculatory Resistance (IMR), measured at the time of primary percutaneous coronary intervention, is predictive of death and rehospitalization for heart failure. Methods and Results-IMR was measured immediately after primary percutaneous coronary intervention in 253 patients from 3 institutions with the use of a pressure-temperature sensor wire. The primary end point was the rate of death or rehospitalization for heart failure.

Background More than 20% of patients presenting to the cardiac catheterization laboratory with angina have no angiographic evidence of coronary artery disease (CAD). Despite a “normal” angiogram, these patients often have persistent symptoms, recurrent hospitalizations, a poor functional status, and adverse cardiovascular outcomes, without a clear diagnosis. Methods and Results In 139 patients with angina in the absence of obstructive CAD (no diameter stenosis >50%), endothelial function was assessed, the index of microcirculatory resistance (IMR), coronary flow reserve (CFR), and fractional flow reserve (FFR) were measured, and intravascular ultrasound (IVUS) was performed. There were no complications. The average age was 54.0±11.4 years and 107 (77%) were women. All patients had at least some evidence of atherosclerosis based on IVUS examination of the LAD. Endothelial dysfunction (a decrease in luminal diameter of >20% after intracoronary acetylcholine) was present in 61 patients (44%). Microvascular impairment (an IMR ≥25) was present in 29 patients (21%). Seven patients (5%) had an FFR ≤0.80. A myocardial bridge was present in 70 patients (58%). Overall, only 32 patients (23%) had no coronary explanation for their angina, with normal endothelial function, normal coronary physiologic assessment, and no myocardial bridging. Conclusions The majority of patients with angina in the absence of obstructive CAD have occult coronary abnormalities. A comprehensive invasive assessment of these patients at the time of coronary angiography can be performed safely and provides important diagnostic information which may affect treatment and outcomes.

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Background-There are currently no guidelines advising long-term surveillance of patients following an acute pulmonary embolism (PE), because long-term outcome studies are rare. We investigated the long-term cardiovascular and all-cause mortality of a large patient cohort with confirmed PE in relation to baseline cardiovascular disease (CVD). Methods and Results-Clinical details of all patients presenting with acute PE to a tertiary hospital were retrieved from medical records, and their survival tracked from a statewide death registry. There were 1023 (45% males) patients admitted with confirmed PE from 2000 to 2007. During a mean follow-up of 3.8Ϯ2.6 years, 363 patients died (35.5%), of whom only 31 (3.0%) died in-hospital during the index PE admission. The 3-month, 6-month, 1-year, 3-year, and 5-year cumulative mortality rates were 8.3%, 11.1%, 16.3%, 26.7%, and 31.6% respectively. Annual mortality did not improve over the 7-year period. The postdischarge mortality of 8.5%/patient-year was 2.5-fold that of an age-and sex-matched general population, being 12.6-fold in the youngest quintile (Ͻ55 years) and 1.9-fold in the oldest quintile (Ն83 years). Patients with known CVD at baseline had 2.2-fold greater all-cause mortality than those without CVD, and this effect, although at a lower level of risk, remained significant after multivariate analysis. Of the 332 deaths occurring postdischarge, 40% were attributed to cardiovascular causes. Conclusions-In a contemporary adult population, PE is associated with a substantially increased long-term mortality, of which nearly half is cardiovascular. Our study highlights the urgent need to develop long-term surveillance strategies in this population. (Circ Cardiovasc Qual Outcomes. 2011;4:122-128.)Key Words: pulmonary embolism Ⅲ long-term Ⅲ mortality Ⅲ predictors Ⅲ cardiovascular Ⅲ heart disease Ⅲ thrombosis V enous thromboembolic disease is a worldwide problem, with acute pulmonary embolism (PE) its most severe manifestation. 1 The outcome of patients with acute PE is only partly (and to a small extent) determined by the size and extent of thrombus burden, and much more by the presence and extent of right ventricular dysfunction. 2 Symptomatic PE can cause death within 1 hour of onset in up to 10% of cases 3 ; it is the third largest cause of cardiovascular death after coronary artery disease and stroke, 4 occurring in up to 7% to 30% of all autopsy series. 1 Predictors of acute mortality following acute PE include: age Ͼ70 years, coexistent malignancy, heart failure, pulmonary disease, systemic hypotension, right ventricular dysfunction, and biomarkers such as cardiac troponins and B-type natriuretic peptide. [5][6][7][8] In contrast to the abundant data regarding acute outcome, predictors of long-term mortality remain poorly defined because of the rarity of large cohort studies. The few studies extending beyond 6 months have indicated an increased 1-year mortality rate after PE, which may be as high as 25%. 9 -11 Increased long-term risk of recurrent PE, cancer, and c...