Vasodilatory Capacity of the Coronary Microcirculation is Preserved in Selected Patients With Non–ST-Segment–Elevation Myocardial Infarction

Layland, Jamie; Carrick, David; McEntegart, Margaret; Ahmed, Nadeem; Payne, A. P.; McClure, John; Sood, Arvind; McGeoch, Ross; MacIsaac, Andrew; Whitbourn, Robert; Wilson, Andrew; Oldroyd, Keith G.; Berry, Colin

doi:10.1161/circinterventions.112.000180

Cited by 114 publications

(93 citation statements)

References 31 publications

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“…Use of FFR has been advocated in patients with non-STEMI(37)(38)(39) and FFR can be used to assess stenosis severity of the nonculprit artery in STEMI(16). However, there are no previous data on using FFR in the culprit artery in STEMI.…”

mentioning

confidence: 99%

Impact of Microvascular Obstruction on the Assessment of Coronary Flow Reserve, Index of Microcirculatory Resistance, and Fractional Flow Reserve After ST-Segment Elevation Myocardial Infarction

Cuculi

Maria

Meier

et al. 2014

Journal of the American College of Cardiology

160

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mentioning

confidence: 99%

Impact of Microvascular Obstruction on the Assessment of Coronary Flow Reserve, Index of Microcirculatory Resistance, and Fractional Flow Reserve After ST-Segment Elevation Myocardial Infarction

Cuculi

Maria

Meier

et al. 2014

Journal of the American College of Cardiology

160

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“…11 On the basis of invasive measurement of coronary vasodilator capacity (resistive reserve ratio), we found that patients with stable angina and NSTEMI have a similar vasodilator reserve. 12 Thus, although recent studies are informative, more data concerning the validity of FFR in NSTEMI are needed.…”

Section: Ffr Vs Mri In Nstemimentioning

confidence: 99%

Assessment of Fractional Flow Reserve in Patients With Recent Non–ST-Segment–Elevation Myocardial Infarction

Layland

Rauhalammi

Watkins

et al. 2015

Circ: Cardiovascular Interventions

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F ractional flow reserve (FFR) has an established role in guiding percutaneous coronary intervention (PCI) in stable coronary artery disease (CAD). In this setting, the use of FFR has been associated with improved long-term outcomes and reduced healthcare costs compared with angiographic-based strategies.1 Rates of urgent revascularization are reduced whenBackground-The use of fractional flow reserve (FFR) in acute coronary syndromes is controversial. The British Heart Foundation Fractional Flow Reserve Versus Angiography in Guiding Management to Optimize Outcomes in Non-STElevation Myocardial Infarction (FAMOUS-NSTEMI) study (NCT01764334) has recently demonstrated the safety and feasibility of FFR measurement in patients with non-ST-segment-elevation myocardial infarction. We report the findings of the cardiac magnetic resonance (CMR) substudy to assess the diagnostic accuracy of FFR compared with 3.0-T stress CMR perfusion. Methods and Results-One hundred six patients with non-ST-segment-elevation myocardial infarction who had been referred for early invasive management were included from 2 centers. FFR was measured in all major patent epicardial coronary arteries with a visual stenosis estimated at ≥30%, and if percutaneous coronary intervention was performed, an FFR assessment was repeated. Myocardial perfusion was assessed with stress perfusion CMR at 3 T. The mean age was 56.7±9.8 years; 82.6% were men. Mean time from FFR evaluation to CMR was 6.1±3.1 days. The mean±SD left ventricular ejection fraction was 58.2±9.1%. Mean infarct size was 5.4±7.1%, and mean troponin concentration was 5.2±9.2 μg/L. There were 34 fixed and 160 inducible perfusion defects. There was a negative correlation between the number of segments with a perfusion abnormality and FFR (r=−0.77; P<0.0001). The overall sensitivity, specificity, positive predictive value, and negative predictive value for an FFR of ≤0.8 were 91.4%, 92.2%, 76%, and 97%, respectively. Diagnostic accuracy was 92%. The positive and negative predictive values of FFR for flow-limiting coronary artery disease (FFR≤0.8) in patients with non-ST-segment-elevation myocardial infarction (n=21) who underwent perfusion CMR before invasive angiography were 92% and 93%, respectively. Receiver operating characteristic analysis indicated that the optimal cutoff value of FFR for demonstrating reversible ischemia on CMR was ≤0.805 (area under the receiver operating characteristic curve, 0.94 [0.9-0.99]; P<0.0001). Conclusions-FFR in patients with recent non-ST-segment-elevation myocardial infarction showed high concordance with myocardial perfusion in matched territories as revealed by 3.0-T stress perfusion CMR. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02073422.

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“…This is the basic physiological principle underlying FFR. In ACS, there is potential disruption to the microcirculation from cell death, peri-infarct oedema, microembolic disease and local vasospasm [31]. In this situation there may be a failure to achieve maximal hyperaemia so that pressure measurements will not be proportional to coronary flow and FFR may be inaccurate.…”

Section: Issues In St Segment Elevation Myocardial Infarctionmentioning

confidence: 99%

“…Furthermore, by using a surrogate of a hyperaemic response in 40 patients with acute STEMI, it has been shown that such patients have e28 Coronary Artery Disease 2015, Vol 26 Supplement 1 lowered vasodilatory capacity when compared to stable patients. Intuitively, there was also lower coronary flow reserve and higher index of microvascular resistance in acute STEMI [31]. Thus in patients with acute STEMI the assessment of FFR in the culprit vessel is not recommended.…”

Section: Issues In St Segment Elevation Myocardial Infarctionmentioning

confidence: 99%

“…Interestingly, the RRR was negatively correlated with troponin and the index of microvascular resistance suggesting that in fact it is the degree of myocardial injury that determines the ability to achieve a hyperaemic response. As NSTEMI is characterized by smaller troponin elevations and lower index of microvascular resistance, the ability to achieve maximal hyperaemia and thus use FFR will be more likely compared to STEMI [31].…”

Section: After Infarctionmentioning

confidence: 99%

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Beyond FAMOUS-NSTEMI

Nerlekar

Layland

2015

Coronary Artery Disease

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Fractional flow reserve (FFR) is a well-established method of assessing haemodynamically significant coronary artery stenoses that has demonstrated improved outcomes when used to guide revascularization decisions in patients with stable coronary artery disease. However, the role of FFR in the setting of acute coronary syndrome (ACS) remains uncertain. The recently published FAMOUS-NSTEMI trial was a pilot study that demonstrated the safety of routine FFR in ACS patients as well as its impact upon refining management decisions in patients with stenoses of varying severity in nonculprit arteries. The goal of this review is to summarize the current literature of the utility of FFR in the ACS population and highlight the role that the results of FAMOUS-NSTEMI may have on future study and management in this area.

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Vasodilatory Capacity of the Coronary Microcirculation is Preserved in Selected Patients With Non–ST-Segment–Elevation Myocardial Infarction

Cited by 114 publications

References 31 publications

Impact of Microvascular Obstruction on the Assessment of Coronary Flow Reserve, Index of Microcirculatory Resistance, and Fractional Flow Reserve After ST-Segment Elevation Myocardial Infarction

Impact of Microvascular Obstruction on the Assessment of Coronary Flow Reserve, Index of Microcirculatory Resistance, and Fractional Flow Reserve After ST-Segment Elevation Myocardial Infarction

Assessment of Fractional Flow Reserve in Patients With Recent Non–ST-Segment–Elevation Myocardial Infarction

Beyond FAMOUS-NSTEMI

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