Comparison of a Fully Angiography-Derived Versus a Hybrid of Angiography and Pressure-Wire-Derived Approach to Assess Coronary Microvascular Resistance: The Oxford Acute Myocardial Infarction Hybrid (OxAMI-HYBRID) Study.
Jason Chai, Federico Marin, Roberto Scarsini, Rafail Kotronias, Stefano Benenati, Miao Chu, Liam S Couch, Jeremy Langrish, Keith Channon, Adrian Banning, Giovanni Luigi De Maria
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引用次数: 0
Abstract
Background: Despite growing evidence of its clinical implications, assessment of coronary microvascular dysfunction (CMD) remains limited in routine clinical practice. Hence, there is an increasing interest in angiography-derived indices to encourage assessment of CMD in the cardiac catheterisation laboratory.
Aims: We investigate here an alternative approach, using a combination of pressure-wire-based assessment of distal coronary pressure (Pd) and an angiography-derived surrogate of coronary flow, to derive a hybrid index of microcirculatory resistance (IMRhybrid).
Methods: Patients enroled prospectively under the Oxford Acute Myocardial Infarction (OxAMI) study were included in the OxAMI HYBRID substudy. The accuracy of IMRhybrid was assessed in diagnosing CMD using bolus thermodilution-based Index of Microcirculatory Resistance (IMR) as a reference. The accuracy of IMRhybrid was then compared against a fully angiography-derived index of microvascular resistance (IMRangio).
Results: One hundred and eighty six patients were enroled, of which 121 with acute coronary syndrome and 65 with stable coronary artery disease. A total of 240 vessel analyses were performed. Both IMRhybrid and IMRangio correlated with IMR (rho = 0.71, p < 0.001 and rho = 0.71, p < 0.001 respectively) and showed good and comparable overall diagnostic accuracy in predicting IMR ≥ 25 (80.8% and 83.1% respectively) with a receiver operator curve (ROC) analyses showing similar AUC of 0.86 (95% CI 0.82-0.91, p < 0.001) for IMRhybrid and 0.86 (95% CI 0.809-0.906, p < 0.001) for IMRangio, p for comparison = 0.641.
Conclusion: Both approaches, IMRhybrid and IMRangio are viable and comparable indices correlating with bolus thermodilution-based IMR and retaining good diagnostic accuracy. IMRhybrid specifically is a simple alternative to conventional bolus thermodilution-based IMR applicable to any pressure wire system.
期刊介绍：
Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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