title: Fractional flow reserve for the assessment of nonculprit coronary artery stenoses in patients with acute myocardial infarction.
abstract: OBJECTIVE
  We investigated the reliability of fractional flow reserve (FFR) of nonculprit coronary stenoses during percutaneous coronary intervention (PCI) in acute myocardial infarction.
  
  
  BACKGROUND
  Assessing the hemodynamic severity of the nonculprit coronary artery stenoses at the acute phase of a myocardial infarction could improve risk stratification and shorten the diagnostic work-up.
  
  
  METHODS
  One hundred one patients undergoing PCI for an acute myocardial infarction (n = 75 with ST-segment elevation myocardial infarction [STEMI], and n = 26 with non-ST-segment elevation myocardial infarction) were prospectively recruited. The FFR measurements in 112 nonculprit stenoses were obtained immediately after PCI of the culprit stenosis and were repeated 35 ± 4 days later. In addition, left ventricular ejection fraction, quantitative coronary angiographic measurements of the nonculprit stenoses, Thrombolysis In Myocardial Infarction (TIMI) flow, corrected TIMI frame count (cTFC), and the index of microcirculatory resistance (n = 14) of the nonculprit vessels were assessed in the acute phase and at control angiogram.
  
  
  RESULTS
  The FFR value of the nonculprit stenoses did not change between the acute and follow-up (0.77 ± 0.13 vs. 0.77 ± 0.13, respectively, p = NS). In only 2 patients, the FFR value was higher than 0.8 at the acute phase and lower than 0.75 at follow-up. The TIMI flow, cTFC, percentage diameter stenosis, minimum lumen diameter, and index of microcirculatory resistance did not change. Left ventricular ejection fraction increased significantly in patients with STEMI (from 54 ± 13% to 57 ± 13%, p = 0.03).
  
  
  CONCLUSIONS
  During the acute phase of acute coronary syndromes, the severity of nonculprit coronary artery stenoses can reliably be assessed by FFR. This allows a decision about the need for additional revascularization and might contribute to a better risk stratification.
authors.affiliation: Cardiovascular Center, Aalst, OLV Clinic, Moorselbaan 164, Aalst, Belgium.
authors.forename: Argyrios
authors.initials: A
authors.lastname: Ntalianis
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Sels
authors.forename: Giedrius
authors.initials: G
authors.lastname: Davidavicius
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tanaka
authors.forename: Olivier
authors.initials: O
authors.lastname: Muller
authors.forename: Catalina
authors.initials: C
authors.lastname: Trana
authors.forename: Emanuele
authors.initials: E
authors.lastname: Barbato
authors.forename: Michalis
authors.initials: M
authors.lastname: Hamilos
authors.forename: Fabio
authors.initials: F
authors.lastname: Mangiacapra
authors.forename: Guy R
authors.initials: GR
authors.lastname: Heyndrickx
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.forename: Nico H J
authors.initials: NH
authors.lastname: Pijls
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006305:Health Status Indicators; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D011446:Prospective Studies; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D016277:Ventricular Function, Left