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Prognostic implication of coronary slow flow assessed by cTFC in patients with myocardial infarction with Non-obstructive coronary arteries

  • Redhwan M. Mareai
    Affiliations
    Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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  • Abdul-Quddus Mohammed
    Affiliations
    Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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  • Hengbin Zhang
    Affiliations
    Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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  • Lu Liu
    Affiliations
    Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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  • Wen Zhang
    Affiliations
    Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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  • Ayman A. Mohammed
    Affiliations
    Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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  • Guoqing Yin
    Affiliations
    Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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  • Xian Lv
    Affiliations
    Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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  • Yawei Xu
    Correspondence
    Corresponding authors at: Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai 200072, China.
    Affiliations
    Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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  • Fuad A. Abdu
    Correspondence
    Corresponding authors at: Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai 200072, China.
    Affiliations
    Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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  • Wenliang Che
    Correspondence
    Corresponding authors at: Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai 200072, China.
    Affiliations
    Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China

    Department of Cardiology, Shanghai Tenth People's Hospital Chongming branch, Shanghai, China
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Published:December 02, 2022DOI:https://doi.org/10.1016/j.ejim.2022.11.026

      Highlights

      • Coronary slow flow (CSF) is commonly linked to worse cardiovascular events and life-threatening arrhythmias.
      • The prognostic impact of CSF on myocardial infarction with the non-obstructive coronary artery (MINOCA) has never been studied.
      • Our results demonstrated that CSF is associated with a higher risk of adverse events and is an independent predictor of clinical outcomes among patients with MINOCA.
      • CSF may serve as a robust tool to stratify high-risk MINOCA patients to prompt a close follow-up and improve overall survival.

      Abstract

      Background

      Coronary slow flow (CSF) is common and linked to worse cardiovascular events and life-threatening arrhythmias. However, the clinical implication of CSF among myocardial infarction with the non-obstructive coronary artery (MINOCA) has never been studied. We aimed to evaluate the impact of CSF on the MINOCA population.

      Methods

      Patients diagnosed with MINOCA were consecutively selected. The corrected TIMI frame count (cTFC) was used to evaluate the coronary flow. CSF was defined as cTFC greater than 27 frames per second (FPS) in any of the three coronary arteries. Major adverse cardiovascular events (MACE) are the primary endpoint. Cox regression analysis was used to evaluate the association between CSF and MACE.

      Results

      A total of 158 patients with MINOCA were enrolled, of which 54 (34.2%) patients had CSF. Forty incidents of MACE occurred during the median 28 months of follow-up. The MACE incidence was higher among patients who presented with CSF than the normal coronary flow patients (35.2% vs. 20.2%, p = 0.040). In the Kaplan-Meier analysis, CSF patients had significantly higher rates of MACE (log-rank P = 0.034). Multivariate Cox regression analysis showed that CSF was an independent predictor linked to an increased hazard of MACE (adjusted HR, 2.76; 95% CI, 1.34–5.67; P = 0.006).

      Conclusion

      The presence of CSF is associated with a higher risk of adverse events and is an independent predictor of clinical outcomes among patients with MINOCA. This result suggests that CSF might serve as a robust tool to stratify MINOCA patients.

      Graphical abstract

      Keywords

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