Author + information
- Received December 5, 2019
- Revision received February 21, 2020
- Accepted March 2, 2020
- Published online May 18, 2020.
- Seung Hun Lee, MD, PhDa,∗,
- Hyun Kuk Kim, MD, PhDb,∗,
- Joo Myung Lee, MD, MPH, PhDa,∗ (, )
- Young Joon Hong, MD, PhDc,∗ (, )
- Kyung Seob Lim, DVM, PhDd,
- Han Byul Kim, MSc,
- Ki Hong Choi, MDa,
- Eun-Seok Shin, MD, PhDe,
- Chang-Wook Nam, MD, PhDf,
- Joon-Hyung Doh, MD, PhDg,
- Jeong Hoon Yang, MD, PhDa,
- Young Bin Song, MD, PhDa,
- Joo-Yong Hahn, MD, PhDa,
- Seung-Hyuk Choi, MD, PhDa,
- Myung Ho Jeong, MD, PhDc,
- Habib Samady, MD, PhDh and
- Javier Escaned, MD, PhDi
- aDivision of Cardiology, Department of Internal Medicine, 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, Chonnam National University Hospital, Gwangju, Korea
- dFuturistic Animal Resource & Research Center, Korea Research Institute of Bioscience and Biotechnology, Cheongju, Korea
- eDivision of Cardiology, Department of Internal Medicine, Ulsan Medical Center, Ulsan Hospital, Ulsan, Korea
- fDepartment of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
- gDepartment of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
- hAndreas Gruentzig Cardiovascular Center, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- iHospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
- ↵∗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.
- ↵∗Dr. Young Joon Hong, Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, 42 Jaebongro, Dong Ku, Gwangju 61469, Republic of Korea.
Objectives The aim of this study was to evaluate temporal changes in coronary hemodynamic and physiological indexes in the non-infarct-related artery (IRA), which might be affected by adjacent infarcted myocardium, using an experimental animal model of acute myocardial infarction.
Background There has been debate on the reliability of fractional flow reserve and resting pressure-derived indexes, including instantaneous wave-free ratio, in the non-IRA in patients with acute ST-segment elevation myocardial infarction.
Methods In Yorkshire swine, acute myocardial infarction was simulated with selective balloon occlusion at the left circumflex coronary artery as the IRA for 30 min. Non-IRA stenosis was created using bare-metal stent implantation in the left anterior descending coronary artery 4 weeks before the experiments. Serial changes in systemic hemodynamic status, coronary pressure, and Doppler-derived coronary flow velocity were measured in a nonoccluded left anterior descending coronary artery as the non-IRA from baseline, balloon occlusion of the left circumflex coronary artery, and 15 min after reperfusion of the left circumflex coronary artery.
Results Among the 6 experimental subjects, the median diameter stenosis of the non-IRA was 33.9% (interquartile range: 21.7% to 46.1%). During balloon occlusion of the IRA, there were transient significant changes in both resting and hyperemic aortic pressure, distal coronary pressure, averaged peak velocity, transstenotic pressure gradient, and microvascular resistance of the non-IRA (p < 0.020 for all). After reperfusion of the IRA, the resting averaged peak velocity (p = 0.002) and resting transstenotic pressure gradient (p = 0.004) were significantly increased and resting microvascular resistance (p = 0.004) was significantly decreased compared with their values in the baseline phase. However, the hyperemic averaged peak velocity (p = 0.479), hyperemic transstenotic pressure gradient (p = 0.778), and hyperemic microvascular resistance (p = 0.816) were not significantly different compared with those in the baseline phase. After reperfusion, fractional flow reserve in the non-IRA was not significantly different (0.94 ± 0.01 vs. 0.93 ± 0.01; p = 0.353), while coronary flow reserve (1.93 ± 0.07 vs. 1.36 ± 0.07; p = 0.025) and instantaneous wave-free ratio (0.97 ± 0.01 vs. 0.93 ± 0.01; p = 0.001) were significantly lower than baseline values.
Conclusions In a porcine model of acute myocardial infarction, occlusion of the IRA induced significant changes in systemic hemodynamic status and coronary circulatory indexes of the non-IRA. However, after reperfusion of the IRA, fractional flow reserve did not change significantly, whereas coronary flow reserve and instantaneous wave-free ratio showed significant changes compared with baseline values.
- acute coronary syndrome
- acute myocardial infarction
- coronary flow reserve
- fractional flow reserve
- instantaneous wave-free ratio
↵∗ Drs. S.H. Lee and H.K. Kim contributed equally to this work.
This study was supported by a research grant from the Bio & Medical Technology Development Program of the National Research Foundation of the Korean government (2018M3A9E2024584) and was also partly supported by a research grant from Philips/Volcano. The company and funder had no role in study design, conduct, data analysis, or manuscript preparation. Dr. J.M. Lee has received research grants from St. Jude Medical (Abbott Vascular) and Philips Volcano. Prof. Hahn has received research grants from St. Jude Medical (Abbott Vascular), Boston Scientific, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received December 5, 2019.
- Revision received February 21, 2020.
- Accepted March 2, 2020.
- 2020 American College of Cardiology Foundation
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