背景:在5%-25%的非ST段抬高急性冠脉综合征(NSTE-ACS)患者中,冠状动脉造影显示无阻塞性冠状动脉(MINOCA).冠状动脉微血管疾病(CMD)是这些患者的潜在因果病理生理机制,可以通过连续热稀释评估来诊断。最近,微血管阻力储备(MRR)作为评估微循环血管舒张能力的新指标被引入.然而,从未在MINOCA患者的急性环境中对连续热稀释和MRR进行过研究,目前缺乏对这些患者微循环的侵入性评估.
目的:本研究的目的是调查MINOCA患者CMD(MRR≤2.7)的发生率,并评估在急性冠状动脉造影指数期间进行基于热稀释的连续评估的可行性和安全性。
方法:这项研究是一项前瞻性的,观察,研究MINOCA患者急性冠状动脉生理学的初步研究。确诊为NSTE-ACS的患者符合入选条件。
结果:总计,19名MINOCA患者纳入本分析;平均年龄为70±9岁,79%是女性。6例患者存在CMD(32%)。与MRR>2.7组相比,MRR≤2.7组的Qrest显着升高(0.076[0.057-0.100]vs.0.049[0.044-0.071]L/min,p=0.03)。Rµ,与MRR>2.7组相比,MRR≤2.7组的休息时间显着降低(1083[710-1510]与1563[1298-1970]WU,p=0.04)。在索引冠状动脉造影期间的连续热稀释评估期间,未发生围手术期并发症或血流动力学不稳定。
结论:在接受立即冠状动脉造影的MINOCA患者中,连续热稀释评估和MRR在急性环境中是可行和安全的,在三分之一的MINOCA患者中可以观察到功能性CMD的证据。
BACKGROUND: In 5%-25% of non-ST-elevation acute coronary syndrome (NSTE-ACS) patients, coronary angiography reveals no obstructive coronary arteries (MINOCA). Coronary microvascular disease (CMD) is a potential causal pathophysiological mechanism in these patients and can be diagnosed by continuous thermodilution assessment. Recently, the microvascular resistance reserve (MRR) has been introduced as a novel index to assess the vasodilatory capacity of the microcirculation. However, continuous thermodilution and MRR have never been investigated in the acute setting in MINOCA patients and invasive assessment of the microcirculation in these patients are currently lacking.
OBJECTIVE: The objectives of the study were to investigate the incidence of CMD (MRR ≤ 2.7) in patients with MINOCA and to evaluate the feasibility and safety of continuous thermodilution-based assessment during index coronary angiography in the acute setting.
METHODS: This study was a prospective, observational, pilot study investigating coronary physiology in the acute setting in MINOCA patients. Patients admitted with a diagnosis of NSTE-ACS were eligible for inclusion.
RESULTS: In total, 19 MINOCA patients were included in this analysis; the mean age was 70 ± 9 years, and 79% were females. CMD was present in 6 patients (32%). Qrest was significantly higher in the MRR ≤ 2.7 group compared to the MRR > 2.7 group (0.076 [0.057-0.100] vs. 0.049 [0.044-0.071] L/min, p = 0.03). Rµ,rest was significantly lower in the MRR ≤ 2.7 group compared to the MRR > 2.7 group (1083 [710-1510] vs. 1563 [1298-1970] WU, p = 0.04). No periprocedural complications or hemodynamic instability have occurred during continuous thermodilution assessment during the index coronary angiography.
CONCLUSIONS: In patients admitted for MINOCA undergoing immediate coronary angiography, continuous thermodilution assessment and MRR are feasible and safe in the acute setting, and evidence of functional CMD could be observed in one-third of the MINOCA patients.