Increased Thrombogenicity is Associated With Coronary Microvascular Dysfunction in Patients With STEMI-A Proof-of-Concept Study

BackgroundUp to 50% of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) develop coronary microvascular dysfunction (CMD).AimsThis study aims to assess whether a prothrombotic state of coronary blood, defined by thromboelastography (TEG), is associated with post-pPCI CMD in STEMI.MethodsTEG analysis of infarct-related coronary artery (IRA) blood was performed in 25 consecutive STEMI patients before and after successful pPCI. CMD was defined by high values of the angiography-derived index of microcirculatory resistance (IMRangio >= 40 units).ResultsThe median age was 59 (IQR 51-71) years. CMD was observed in 13 (52%) patients. Pre-pPCI Reaction (R) and Kinetic (K) time of the coronary blood from the IRA were inversely correlated with IMRangio (rho -0.45, p = 0.02; rho -0.62, p = 0.002 respectively). R time was significantly shorter in patients who developed CMD (10.7 [IQR 8.8, 13.1] vs. 18.2 [IQR 12.6, 24.2], p = 0.05), and it provided an overall good diagnostic accuracy in predicting CMD (AUC 0.75, [95% CI 0.53-0.96] p = 0.05). Similar relationship was founded for K time: 3.5 [IQR 2.2-4.6] versus 10.6 [IQR 4.5-30.0] min, p = 0.01; AUC 0.82, [95% CI 0.64-0.99] p = 0.01. Moreover, alpha angle was significantly larger (57.4 [IQR 46.5-64.8] vs. 40.0 [IQR 39.0-49.5], p = 0.03) in patients with CMD (AUC 0.78, [95% CI 0.57-0.98], p = 0.03). Coronary post-pPCI TEG parameters were not associated with CMD.ConclusionsIn this proof-of-concept study, a prothrombotic state of coronary blood from the IRA is associated with CMD. Further studies are warranted to evaluate if TEG may enhance individualized therapies in patients with STEMI at risk of CMD.