BACKGROUND Coronary microvascular dysfunction before percutaneous coronary intervention (PCI) predicts PCI-related myocardial injury in patients with stable coronary artery disease (CAD). Whether the dynamic changes of the microcirculation during PCI might be associated with the occurrence of procedure-related myocardial injury and infarction is still unclear. We aimed to investigate the impact of pre- and post-PCI microvascular function, evaluated with the index of microvascular resistance (IMR) on the occurrence of PCI-related myocardial injury and infarction. METHODS In consecutive patients with stable CAD referred for elective PCI, coronary physiological indexes, including IMR, were measured before and after revascularization. High sensitivity Troponin T (hs-TnT) was assessed up to 24 h after PCI, and PCI-related myocardial injury and type 4a myocardial infarction (MI) were defined according to the fourth universal definition of myocardial infarction. RESULTS In the 50 patients enrolled, a significant correlation was found between maximum post-PCI hs-Tn and IMR, both at baseline (rho = 0.309, p=0.029) and post-PCI (rho = 0.378, p=0.007). Patients who developed type 4a MI, compared with patients who did not, presented significantly higher IMR levels, both at baseline (28.3 ± 12.2 vs. 19.6 ± 8.8, p=0.020) and post-PCI (45.4 ± 21.3 vs. 21.6 ± 11.2, p<0.0001). Patients with post-PCI IMR > 38 showed significantly higher maximum post-PCI hs-Tn levels (105.4 [49.4-126.9] vs. 22.4 [11.7-38.6] ng/ml, p<0.0001), and developed type 4a MI more frequently (66.8% vs. 4.9%, p<0.0001). CONCLUSIONS Dynamic changes of microvascular resistance post-PCI are strongly correlated with PCI-related myocardial injury and post-PCI IMR is a strong predictor of type 4a MI in patients with stable CAD undergoing elective PCI.

中文翻译：

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选择性经皮冠状动脉介入治疗期间的冠状动脉微循环和围手术期心肌损伤。

背景技术经皮冠状动脉介入治疗（PCI）之前的冠状动脉微血管功能障碍可预测稳定冠状动脉疾病（CAD）患者的PCI相关性心肌损伤。尚不清楚PCI期间微循环的动态变化是否可能与手术相关的心肌损伤和梗塞的发生有关。我们旨在调查PCI前后的微血管功能的影响，并通过微血管阻力指数（IMR）对PCI相关的心肌损伤和梗塞的发生进行评估。方法在连续的患有稳定CAD称为用于选择性PCI，冠状动脉生理指标，包括IMR，前和血管重建术后进行测定。在PCI术后24小时内评估了高敏感性肌钙蛋白T（hs-TnT），根据第四个通用的心肌梗死定义，定义与PCI相关的心肌损伤和4a型心肌梗塞（MI）。结果在入组的50例患者中，在基线时（rho = 0.309，p = 0.029）和PCI术后（rho = 0.378，p = 0.007），PCI后hs-Tn和IMR的最大值之间存在显着相关性。发生4a型MI的患者与未发生4a型MI的患者相比，在基线时（28.3±12.2 vs. 19.6±8.8，p = 0.020）和PCI后（45.4±21.3 vs. 21.6±11.2）表现出明显更高的IMR水平。 ，p ＜0.0001）。PCI后IMR> 38的患者显示最高PCI后hs-Tn水平显着升高（105.4 [49.4-126.9] vs. 22.4 [11.7-38.6] ng / ml，p <0.0001），并且更频繁地出现4a型MI （66.8％对4.9％，p <0.0001）。