Author + information
- Received May 23, 2018
- Revision received June 26, 2018
- Accepted June 27, 2018
- Published online September 17, 2018.
- Ki Hong Choi, MDa,
- Joo Myung Lee, MD, MPH, PhDa,∗ (, )
- Hyun Kuk Kim, MD, PhDb,
- Jihoon Kim, MDa,
- Jonghanne Park, MDc,
- Doyeon Hwang, MDc,
- Tae-Min Rhee, MDc,
- Taek Kyu Park, MD, PhDa,
- Jeong Hoon Yang, MDa,d,
- Young Bin Song, MD, PhDa,
- Eun-Seok Shin, MD, PhDe,f,
- Chang-Wook Nam, MD, PhDg,
- Joon-Hyung Doh, MD, PhDh,
- Joo-Yong Hahn, MD, PhDa,
- Jin-Ho Choi, MD, PhDa,
- Seung-Hyuk Choi, MD, PhDa,
- Bon-Kwon Koo, MD, PhDc,i and
- Hyeon-Cheol Gwon, MD, PhDa
- aDepartment of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- bDepartment of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
- cDepartment of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- dDepartment of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- eDivision of Cardiology, Dietrich Bonhoeffer Hospital, Academic Teaching Hospital of University of Greifswald, Greifswald, Germany
- fDepartment of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
- gDepartment of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
- hDepartment of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
- iInstitute on Aging, Seoul National University, Seoul, Korea
- ↵∗Address for correspondence:
Dr. Joo Myung Lee, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
Objectives The aim of this study was to compare the changes of fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) with severity of epicardial coronary stenosis between nonculprit vessel of acute myocardial infarction (AMI) and stable ischemic heart disease (SIHD).
Background There has been debate regarding the reliability of FFR or iFR for nonculprit stenosis in the acute stage of AMI.
Methods A total of 100 AMI patients underwent comprehensive physiologic assessment including FFR, iFR, coronary flow reserve (CFR), and index of microcirculatory resistance (IMR) for nonculprit vessel stenosis after primary percutaneous coronary intervention (PCI) for culprit vessel. The changes in FFR and iFR for diameter stenosis (%DS) of nonculprit vessel stenosis were compared with FFR and iFR measured in 203 patients with SIHD.
Results From 40% to 80% stenosis, FFR and iFR measured in nonculprit vessel of AMI patient showed significant decrease with worsening stenosis severity (all p values < 0.001). Nonculprit vessels of AMI patients showed lower CFR than SIHD; however, IMR was not different between the nonculprit vessel of AMI and SIHD patients. FFR and iFR were not significantly different between the nonculprit vessel of AMI and SIHD patients in all %DS groups from 40% to 80% (all p values > 0.05). In addition, percent difference of FFR and iFR according to the increase in %DS was also not significantly different between nonculprit vessel of AMI or SIHD. There was no significant interaction between clinical presentation and the changes of FFR and iFR for worsening %DS (interaction p value = 0.698 and 0.257, respectively).
Conclusions Changes in FFR and iFR for the nonculprit stenosis of AMI patients were not significantly different from those in SIHD patients. These data support the use of invasive physiological parameters to guide treatment of nonculprit stenoses in the acute stage of successfully revascularized AMI.
- acute myocardial infarction
- coronary flow reserve
- fractional flow reserve
- index of microcirculatory resistance
- instantaneous wave-free ratio
Dr. Lee has received research grant support from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Koo has received institutional research grant support from St. Jude Medical (Abbott Vascular) and Philips Volcano. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 23, 2018.
- Revision received June 26, 2018.
- Accepted June 27, 2018.
- 2018 American College of Cardiology Foundation