Prognostic Value of Coronary Sinus Flow Quantification by Cardiac Magnetic Resonance Imaging in Patients With Acute Myocardial Infarction

• Published in: Journal of the American Heart Association 2022-03, Vol.11 (5), p.e023519-e023519
• Main Authors: Kanaji, Yoshihisa, Sugiyama, Tomoyo, Hoshino, Masahiro, Yasui, Yumi, Nogami, Kai, Ueno, Hiroki, Yun, Teng, Nagamine, Tatsuhiro, Misawa, Toru, Hada, Masahiro, Yamaguchi, Masao, Hamaya, Rikuta, Usui, Eisuke, Murai, Tadashi, Yonetsu, Taishi, Sasano, Tetsuo, Kakuta, Tsunekazu
• Format: Article
• Language: English
• Subjects: cardiac magnetic resonance imaging; coronary flow reserve; Coronary Sinus - diagnostic imaging; Humans; Hyperemia; Magnetic Resonance Imaging; microvascular disease; myocardial blood flow; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - etiology; Myocardial Infarction - therapy; Non-ST Elevated Myocardial Infarction; Original Research; Percutaneous Coronary Intervention - adverse effects; Predictive Value of Tests; primary percutaneous coronary intervention; Prognosis; Retrospective Studies; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - surgery; Treatment Outcome
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.121.023519

Background This study aimed to evaluate the prognostic value of hyperemic coronary sinus flow (h-CSF) and global coronary flow reserve (g-CFR) obtained by phase-contrast cine-magnetic resonance imaging in patients with acute myocardial infarction (MI). Methods and Results This retrospective study analyzed patients with acute MI (n=523) who underwent primary (ST-segment-elevation MI) or urgent (non-ST-segment-elevation MI) percutaneous coronary intervention. Absolute coronary sinus blood flow (CSF) at rest and during vasodilator stress hyperemia was quantified at 30 days (24-36 days) after the index infarct-related lesion percutaneous coronary intervention and revascularization of functionally significant non-infarct-related lesions. We used Cox proportional hazards regression modeling to examine the association between h-CSF, g-CFR, and major adverse cardiac events defined as all-cause death, nonfatal MI, hospitalization for congestive heart failure, and stroke. Finally, 325 patients with ST-segment-elevation MI (62.1%) and 198 patients with non-ST-segment-elevation MI (37.9%) were studied over a median follow-up of 2.5 years. The rest CSF, h-CSF, and g-CFR were 0.94 (0.68-1.26) mL/min per g, 2.05 (1.42-2.73) mL/min per g, and 2.17 (1.54-3.03), respectively. Major adverse cardiac events occurred in 62 patients, and Cox proportional hazards analysis showed that h-CSF and g-CFR were independent predictors of major adverse cardiac events (h-CSF: hazard ratio [HR], 0.64; 95% CI, 0.47-0.88; =0.005; g-CFR: HR, 0.62; 95% CI, 0.47-0.82; =0.001). When stratified by h-CSF and g-CFR, cardiac event-free survival was the worst in patients with concordantly impaired h-CSF (