Direct Stenting for Stable Angina Pectoris Is Associated With Reduced Periprocedural Microcirculatory Injury Compared With Stenting After Pre-Dilation
Thomas Cuisset, MD,
Michalis Hamilos, MD,
Narbeh Melikian, MD,
Eric Wyffels, MD,
Jaydeep Sarma, MD,
Giovanna Sarno, MD,
Emanuele Barbato, MD,
Jozef Bartunek, MD,
William Wijns, MD, PhD* and
Bernard De Bruyne, MD, PhD
Cardiovascular Center, OLV Hospital, Aalst, Belgium.
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Figure 1 Measurement of Post-PCI IMR After PCI
IMR = Pd hyperhemia · Tmn hyperhemia. (A) Patient A undergoing direct stenting with low post-PCI IMR value and no troponin release. (B) Patient B undergoing conventional stenting with higher post-PCI IMR value and troponin release (troponin T = 0.042 ng/ml). CFR = coronary flow reserve; FFR = fractional flow reserve; IMR = index of microcirculatory resistance; Pa = arterial pressure; PCI = percutaneous coronary intervention; Pd = distal pressure; Tmn = mean transit time.
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Figure 2 Distribution of IMR Values Among Patients Undergoing DS or CS According to Post-PCI Troponin Values
Closed circles = troponin positive; open circles = troponin negative. CS = conventional stenting; DS = direct stenting; IMR = index of microcirculatory resistance; PCI = percutaneous coronary intervention.
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Figure 3 Relationship Between Individual IMR Values and Corresponding CFR and FFR Post-PCI
(A) Correlation between post-PCI IMR and CFR values, r = –0.38, p = 0.006. (B) Correlation between post-PCI IMR and FFR values, r = 0.15, p = 0.1. Abbreviations as in Figures 1 and 2.
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