Coronary Circulatory Indexes in Non -Infarct -Related Vascular Territories in a Porcine Acute Myocardial Infarction Model

摘要

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 0.002) and resting transstenotic pressure gradient (p 1/4 0.004) were significantly increased and resting microvascular resistance (p 1/4 0.004) was significantly decreased compared with their values in the baseline phase. However, the hyperemic averaged peak velocity (p 1/4 0.479), hyperemic transstenotic pressure gradient (p 1/4 0.778), and hyperemic microvascular resistance (p 1/4 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 1/4 0.353), while coronary flow reserve (1.93 0.07 vs. 1.36 0.07; p 1/4 0.025) and instantaneous wave-free ratio (0.97 0.01 vs. 0.93 0.01; p 1/4 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.