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Zuccarelli V, Andreaggi S, Walsh JL, Kotronias RA, Chu M, Vibhishanan J, Banning AP, De Maria GL. Treatment and Care of Patients with ST-Segment Elevation Myocardial Infarction-What Challenges Remain after Three Decades of Primary Percutaneous Coronary Intervention? J Clin Med 2024; 13:2923. [PMID: 38792463 PMCID: PMC11122374 DOI: 10.3390/jcm13102923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Primary percutaneous coronary intervention (pPCI) has revolutionized the prognosis of ST-segment elevation myocardial infarction (STEMI) and is the gold standard treatment. As a result of its success, the number of pPCI centres has expanded worldwide. Despite decades of advancements, clinical outcomes in STEMI patients have plateaued. Out-of-hospital cardiac arrest and cardiogenic shock remain a major cause of high in-hospital mortality, whilst the growing burden of heart failure in long-term STEMI survivors presents a growing problem. Many elements aiming to optimize STEMI treatment are still subject to debate or lack sufficient evidence. This review provides an overview of the most contentious current issues in pPCI in STEMI patients, with an emphasis on unresolved questions and persistent challenges.
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Affiliation(s)
- Vittorio Zuccarelli
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
| | - Stefano Andreaggi
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiology, Department of Medicine, University of Verona, 37129 Verona, Italy
| | - Jason L. Walsh
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Rafail A. Kotronias
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Miao Chu
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Jonathan Vibhishanan
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Adrian P. Banning
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
- National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford OX3 9DU, UK
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
- National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford OX3 9DU, UK
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Aldujeli A, Tsai TY, Haq A, Tatarunas V, Knokneris A, Briedis K, Unikas R, Onuma Y, Brilakis ES, Serruys PW. Impact of Coronary Microvascular Dysfunction on Functional Left Ventricular Remodeling and Diastolic Dysfunction. J Am Heart Assoc 2024; 13:e033596. [PMID: 38686863 DOI: 10.1161/jaha.123.033596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/21/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is a common complication of ST-segment-elevation myocardial infarction (STEMI) and can lead to adverse cardiovascular events. Whether CMD after STEMI is associated with functional left ventricular remodeling (FLVR) and diastolic dysfunction, has not been investigated. METHODS AND RESULTS This is a nonrandomized, observational, prospective study of patients with STEMI with multivessel disease. Coronary flow reserve and index of microcirculatory resistance of the culprit vessel were measured at 3 months post-STEMI. CMD was defined as index of microcirculatory resistance ≥25 or coronary flow reserve <2.0 with a normal fractional flow reserve. We examined the association between CMD, LV diastolic dysfunction, FLVR, and major adverse cardiac events at 12-month follow-up. A total of 210 patients were enrolled; 59.5% were men, with a median age of 65 (interquartile range, 58-76) years. At 3-month follow-up, 57 patients (27.14%) exhibited CMD. After 12 months, when compared with patients without CMD, patients with CMD had poorer LV systolic function recovery (-10.00% versus 8.00%; P<0.001), higher prevalence of grade 2 LV diastolic dysfunction (73.08% versus 1.32%; P<0.001), higher prevalence of group 3 or 4 FLVR (11.32% versus 7.28% and 22.64% versus 1.99%, respectively; P<0.001), and higher incidence of major adverse cardiac events (50.9% versus 9.8%; P<0.001). Index of microcirculatory resistance was independently associated with LV diastolic dysfunction and adverse FLVR. CONCLUSIONS CMD is present in ≈1 of 4 patients with STEMI during follow-up. Patients with CMD have a higher prevalence of LV diastolic dysfunction, adverse FLVR, and major adverse cardiac events at 12 months compared with those without CMD. REGISTRATION URL: https://www.clinicaltrials.gov; Unique Identifier: NCT05406297.
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Affiliation(s)
- Ali Aldujeli
- Lithuanian University of Health Sciences Kaunas Lithuania
| | - Tsung-Ying Tsai
- CORRIB Research Centre for Advanced Imaging and Core Lab University of Galway Galway Ireland
- Cardiovascular center Taichung Veterans General Hospital Taichung Taiwan
| | - Ayman Haq
- Abbott Northwestern Hospital/Minneapolis Heart Institute Foundation Minneapolis MN
| | | | | | | | - Ramunas Unikas
- Lithuanian University of Health Sciences Kaunas Lithuania
| | - Yoshinobu Onuma
- CORRIB Research Centre for Advanced Imaging and Core Lab University of Galway Galway Ireland
- University Hospital Galway Galway Ireland
| | - Emmanouil S Brilakis
- Abbott Northwestern Hospital/Minneapolis Heart Institute Foundation Minneapolis MN
| | - Patrick W Serruys
- CORRIB Research Centre for Advanced Imaging and Core Lab University of Galway Galway Ireland
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Milasinovic D, Tesic M, Nedeljkovic Arsenovic O, Maksimovic R, Sobic Saranovic D, Jelic D, Zivkovic M, Dedovic V, Juricic S, Mehmedbegovic Z, Petrovic O, Trifunovic Zamaklar D, Djordjevic Dikic A, Giga V, Boskovic N, Klaric M, Zaharijev S, Travica L, Dukic D, Mladenovic D, Asanin M, Stankovic G. Correlation of Non-Invasive Transthoracic Doppler Echocardiography with Invasive Doppler Wire-Derived Coronary Flow Reserve and Their Impact on Infarct Size in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention. J Clin Med 2024; 13:2484. [PMID: 38731013 PMCID: PMC11084315 DOI: 10.3390/jcm13092484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/01/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Coronary microvascular dysfunction is associated with adverse prognosis after ST-segment elevation myocardial infarction (STEMI). We aimed to compare the invasive, Doppler wire-based coronary flow reserve (CFR) with the non-invasive transthoracic Doppler echocardiography (TTDE)-derived CFR, and their ability to predict infarct size. Methods: We included 36 patients with invasive Doppler wire assessment on days 3-7 after STEMI treated with primary percutaneous coronary intervention (PCI), of which TTDE-derived CFR was measured in 47 vessels (29 patients) within 6 h of the invasive Doppler. Infarct size was assessed by cardiac magnetic resonance at a median of 8 months. Results: The correlation between invasive and non-invasive CFR was modest in the overall cohort (rho 0.400, p = 0.005). It improved when only measurements in the LAD artery were considered (rho 0.554, p = 0.002), with no significant correlation in the RCA artery (rho -0.190, p = 0.435). Both invasive (AUC 0.888) and non-invasive (AUC 0.868) CFR, measured in the recanalized culprit artery, showed a good ability to predict infarct sizes ≥18% of the left ventricular mass, with the optimal cut off values of 1.85 and 1.80, respectively. Conclusions: In patients with STEMI, TTDE- and Doppler wire-derived CFR exhibit significant correlation, when measured in the LAD artery, and both have a similarly strong association with the final infarct size.
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Affiliation(s)
- Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Milorad Tesic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Olga Nedeljkovic Arsenovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
- Center for Radiology and Magnetic Resonance, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ruzica Maksimovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
- Center for Radiology and Magnetic Resonance, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dragana Sobic Saranovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
- Center for Nuclear Medicine with PET, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dario Jelic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Milorad Zivkovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Vladimir Dedovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Stefan Juricic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Zlatko Mehmedbegovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Olga Petrovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Danijela Trifunovic Zamaklar
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Ana Djordjevic Dikic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Vojislav Giga
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Nikola Boskovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Marija Klaric
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Stefan Zaharijev
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Lazar Travica
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Djordje Dukic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Djordje Mladenovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Milika Asanin
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Goran Stankovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
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