PMID- 30422990
OWN - NLM
STAT- MEDLINE
DCOM- 20190401
LR  - 20190401
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 13
IP  - 11
DP  - 2018
TI  - Microvascular dysfunction determines infarct characteristics in patients with 
      reperfused ST-segment elevation myocardial infarction: The MICROcirculation in 
      Acute Myocardial Infarction (MICRO-AMI) study.
PG  - e0203750
LID - 10.1371/journal.pone.0203750 [doi]
LID - e0203750
AB  - BACKGROUND: In patients with reperfused ST-elevation myocardial infarction 
      (STEMI) both invasive and non-invasive assessments of microvascular dysfunction, 
      the index of microcirculatory resistance (IMR), and microvascular obstruction 
      (MVO) by cardiovascular magnetic resonance (CMR), independently predict poor 
      long-term outcomes. AIMS: The aims of this study were to investigate whether an 
      invasive parameter (IMR), assessed at the time of primary percutaneous 
      intervention (PPCI), could predict the extent of MVO in proportion to infarct 
      size (MVO index). METHODS: 50 patients presenting with STEMI and TIMI flow </= I in 
      the infarct related artery were prospectively recruited to the study, before 
      undergoing PPCI. All patients underwent invasive IMR assessment at maximal 
      hyperaemia using adenosine, and following stent insertion. CMR was performed on 
      day 2 following STEMI, MVO was assessed both on first-pass rest perfusion (early 
      MVO) and in the late gadolinium enhancement (LGE) images (late MVO) along with 
      infarct size. The MVO index was calculated as the ratio of late MVO/infarct size. 
      Differences between IMR quartiles and the MVO index were investigated. RESULTS: 
      The median IMR was 38.5 (range 9 to 202). The median size of late MVO was 1.9% LV 
      (range 0 to 21.0% LV). IMR predicted late MVO (p<0.01) and as IMR increased, the 
      MVO index increased (r = 0.70, [95% CI 0.53, 0.82], p<0.001). An IMR cut-off of 
      40 significantly predicted the presence of late MVO on CMR (p<0.001). CONCLUSION: 
      IMR measured at the time of PPCI in acutely reperfused STEMI is associated with 
      the presence and severity of infarct damage as measured by the MVO index. TRIAL 
      REGISTRATION: The Microcirculation in Acute Myocardial Infarction (MICRO-AMI). 
      Clinicaltrials.gov NCT01552564. Registered 9th March 2012.
FAU - McAlindon, Elisa
AU  - McAlindon E
AUID- ORCID: 0000-0003-0743-3661
AD  - Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol 
      NHS Trust, Bristol, United Kingdom.
AD  - Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals 
      Bristol NHS Trust and University of Bristol, Bristol, United Kingdom.
AD  - Heart and Lung Institute, New Cross Hospital, Wolverhampton, United Kingdom.
FAU - Pufulete, Maria
AU  - Pufulete M
AD  - Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals 
      Bristol NHS Trust and University of Bristol, Bristol, United Kingdom.
FAU - Harris, Jessica
AU  - Harris J
AD  - Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals 
      Bristol NHS Trust and University of Bristol, Bristol, United Kingdom.
FAU - Lawton, Chris
AU  - Lawton C
AD  - Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals 
      Bristol NHS Trust and University of Bristol, Bristol, United Kingdom.
FAU - Johnson, Tom
AU  - Johnson T
AD  - Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol 
      NHS Trust, Bristol, United Kingdom.
AD  - Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals 
      Bristol NHS Trust and University of Bristol, Bristol, United Kingdom.
FAU - Strange, Julian
AU  - Strange J
AD  - Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol 
      NHS Trust, Bristol, United Kingdom.
AD  - Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals 
      Bristol NHS Trust and University of Bristol, Bristol, United Kingdom.
FAU - Baumbach, Andreas
AU  - Baumbach A
AD  - Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol 
      NHS Trust, Bristol, United Kingdom.
AD  - Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals 
      Bristol NHS Trust and University of Bristol, Bristol, United Kingdom.
AD  - Barts Heart Centre, William Harvey Research Institute, Queen Mary University 
      London, United Kingdom.
FAU - Bucciarelli-Ducci, Chiara
AU  - Bucciarelli-Ducci C
AD  - Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol 
      NHS Trust, Bristol, United Kingdom.
AD  - Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals 
      Bristol NHS Trust and University of Bristol, Bristol, United Kingdom.
LA  - eng
SI  - ClinicalTrials.gov/NCT01552564
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20181113
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Coronary Circulation
MH  - Female
MH  - Gadolinium/administration & dosage
MH  - Humans
MH  - *Magnetic Resonance Angiography
MH  - Male
MH  - *Microcirculation
MH  - Middle Aged
MH  - *Percutaneous Coronary Intervention
MH  - Prospective Studies
MH  - *ST Elevation Myocardial Infarction/diagnostic imaging/physiopathology/surgery
MH  - *Vascular Resistance
PMC - PMC6233915
COIS- The authors have declared that no competing interests exist.
EDAT- 2018/11/14 06:00
MHDA- 2019/04/02 06:00
PMCR- 2018/11/13
CRDT- 2018/11/14 06:00
PHST- 2018/01/02 00:00 [received]
PHST- 2018/08/25 00:00 [accepted]
PHST- 2018/11/14 06:00 [entrez]
PHST- 2018/11/14 06:00 [pubmed]
PHST- 2019/04/02 06:00 [medline]
PHST- 2018/11/13 00:00 [pmc-release]
AID - PONE-D-17-43844 [pii]
AID - 10.1371/journal.pone.0203750 [doi]
PST - epublish
SO  - PLoS One. 2018 Nov 13;13(11):e0203750. doi: 10.1371/journal.pone.0203750. 
      eCollection 2018.