Author + information
- Received September 10, 2018
- Revision received December 20, 2018
- Accepted January 3, 2019
- Published online May 20, 2019.
- Annette M. Maznyczka, MBChB (Hons), BSc (Hons), MSca,b,
- Keith G. Oldroyd, MD (Hons)a,b,
- Peter McCartney, MBChB, BMedScia,b,
- Margaret McEntegart, MBChB, PhDa,b and
- Colin Berry, BSc, MBChB, PhDa,b,∗ ()
- aBritish Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
- bWest of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
- ↵∗Address for correspondence:
Prof. Colin Berry, British Heart Foundation, Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences, 126 University Place, University of Glasgow, Glasgow G12 8TA, United Kingdom.
• Impaired microcirculatory reperfusion negatively affects one-half of all patients following PCI for acute STEMI, and prognosis is affected.
• IMR is a prognostic biomarker, easily measured during primary PCI and useful for risk-stratification for targeted therapy.
• Stratified therapy informed by IMR holds promise. More research is needed to identify novel therapies to prevent and treat microvascular obstruction.
The goal of reperfusion therapies in ST-segment elevation myocardial infarction has evolved to include effective reperfusion of the microcirculation subtended by the culprit epicardial coronary artery. The index of microcirculatory resistance is measured using a pressure- and temperature-sensing coronary guidewire and quantifies microvascular dysfunction. The index of microcirculatory resistance is an independent predictor of microvascular obstruction, infarct size, and adverse clinical outcomes. It has the advantage of being immediately measurable in the catheterization laboratory, before the results of blood biomarkers or noninvasive imaging become available. This provides an opportunity for additional intervention that may alter outcomes. In this review, the authors provide a critical appraisal of the published research on the emerging role of the index of microcirculatory resistance as a tool to guide the stratification of patients for adjunctive therapeutic strategies in acute ST-segment elevation myocardial infarction.
- adjunctive therapy
- index of microcirculatory resistance
- microvascular obstruction
- stratified medicine
- ST-segment elevation myocardial
Dr. Maznyczka is supported by a British Heart Foundation Clinical Research Training Fellowship (FS/16/74/32573). Prof. Berry is supported by a British Heart Foundation Centre for Research Excellence awards (RE/13/5/30177; RE/18/6/34217). The University of Glasgow and Prof. Berry have institutional research and/or consultancy agreements with Abbott Vascular, HeartFlow, Opsens, Philips, and Siemens Healthcare. Dr. Oldroyd has research and/or consultancy agreements with Abbott Vascular, Boston Scientific, and Biosensors. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 10, 2018.
- Revision received December 20, 2018.
- Accepted January 3, 2019.
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