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
Graphical Abstract
Keywords
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References
- Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet. 2018; 392: 1789-1858https://doi.org/10.1016/S0140-6736(18)32279-7
- Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet. 2018; 392: 1736-1788https://doi.org/10.1016/S0140-6736(18)32203-7
- Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American Heart Association.Circulation. 2019; 139: E891-E908https://doi.org/10.1161/CIR.0000000000000670
- Myocardial infarction with nonobstructive coronary arteries (MINOCA): the past, present, and future management.Circulation. 2017; 135: 1490-1493https://doi.org/10.1161/CIRCULATIONAHA.117.027666
- Acute myocardial infarction with no obstructive coronary atherosclerosis: mechanisms and management.Eur Heart J. 2015; 36: 475-481https://doi.org/10.1093/EURHEARTJ/EHU469
- Medical therapy for secondary prevention and long-term outcome in patients with myocardial infarction with nonobstructive coronary artery disease.Circulation. 2017; 135: 1481-1489https://doi.org/10.1161/CIRCULATIONAHA.116.026336
- Myocardial infarction with non-obstructive coronary arteries as compared with myocardial infarction and obstructive coronary disease: outcomes in a Medicare population.Eur Heart J. 2020; 41: 870-878https://doi.org/10.1093/EURHEARTJ/EHZ403
- Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries.Circulation. 2015; 131: 861-870https://doi.org/10.1161/CIRCULATIONAHA.114.011201
- LncRNA NEAT1 Promote Inflammatory Responses in Coronary Slow Flow Through Regulating miR-148b-3p/ICAM-1 Axis.J Inflamm Res. 2021; 14: 2445-2463https://doi.org/10.2147/JIR.S312583
- Coronary slow flow is associated with a worse clinical outcome in patients with Takotsubo syndrome.Heart. 2020; 106https://doi.org/10.1136/HEARTJNL-2019-315909
- The coronary slow flow phenomenon: characteristics, mechanisms and implications.Cardiovasc Diagn Ther. 2011; 1: 37-43https://doi.org/10.3978/j.issn.2223-3652.2011.10.01
- Slow coronary flow: pathophysiology, clinical implications, and therapeutic management.Angiology. 2021; 72: 808-818https://doi.org/10.1177/00033197211004390
- The no-flow phenomenon during diagnostic coronary angiography.Cardiovasc Revasc Med. 2005; 6: 126-132https://doi.org/10.1016/J.CARREV.2005.07.007
- Coronary slow flow phenomenon and risk for sudden cardiac death due to ventricular arrhythmias: a case report and review of literature.Clin Cardiol. 2008; 31: 352-355https://doi.org/10.1002/CLC.20266
- Acute ischemia manifestation in a patient with coronary slow flow phenomenon.J Electrocardiol. 2012; 45: 277-279https://doi.org/10.1016/J.JELECTROCARD.2011.07.003
- Acute coronary syndromes in patients with angiographically normal or near normal (non-obstructive) coronary arteries.Trends Cardiovasc Med. 2018; 28: 541-551https://doi.org/10.1016/J.TCM.2018.05.006
- The what, when, who, why, how and where of myocardial infarction with non-obstructive coronary arteries (MINOCA).Circ J. 2016; 80: 11-16https://doi.org/10.1253/CIRCJ.CJ-15-1096
- Clinical characteristics and outcome in patients with ST-segment and non-ST-segment elevation myocardial infarction without obstructive coronary artery: an observation study from Chinese population.BMC Cardiovasc Disord. 2022; 22https://doi.org/10.1186/s12872-021-02359-x
- Coronary blood flow in myocardial infarction with nonobstructive coronary arteries.Eur Heart J. 2020; 41https://doi.org/10.1093/EHJCI/EHAA946.1802
- P3596The role of MSCT and SPECT in patients with acute coronary syndromes and non-obstructive coronary artery disease.Eur Heart J. 2019; 40https://doi.org/10.1093/EURHEARTJ/EHZ745.0456
- ESC working group position paper on myocardial infarction with non-obstructive coronary arteries.Eur Heart J. 2017; 38: 143-153https://doi.org/10.1093/eurheartj/ehw149
- Fourth universal definition of myocardial infarction (2018).Eur Heart J. 2019; 40: 237-269https://doi.org/10.1093/eurheartj/ehy462
- TIMI frame count: a quantitative method of assessing coronary artery flow.Circulation. 1996; 93: 879-888https://doi.org/10.1161/01.cir.93.5.879
- Relationship between plasma total homocysteine levels and mean corrected TIMI frame count in patients with acute myocardial infarction.Int J Gen Med. 2021; 14: 8161-8172https://doi.org/10.2147/IJGM.S338938
- An updated definition of stroke for the 21st century.Stroke. 2013; 44 (Buddy): 2064-2089https://doi.org/10.1161/STR.0b013e318296aeca
- 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.Eur J Heart Fail. 2016; 18: 891-975https://doi.org/10.1002/ejhf.592
- Patients with acute myocardial infarction and non-obstructive coronary arteries: safety and prognostic relevance of invasive coronary provocative tests.Eur Heart J. 2018; 39: 91-98https://doi.org/10.1093/EURHEARTJ/EHX667
- 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.Eur Heart J. 2021; 42: 1289-1367https://doi.org/10.1093/EURHEARTJ/EHAA575
- The coronary slow flow phenomenon–a new coronary microvascular disorder.Cardiology. 2002; 97: 197-202https://doi.org/10.1159/000063121
- Slow coronary flow: a distinct angiographic subgroup in syndrome X.Angiology. 2001; 52: 507-514https://doi.org/10.1177/000331970105200801
- Prevalence and predictors of slow flow in angiographically normal coronary arteries.Clin Hemorheol Microcirc. 2012; 52: 5-14https://doi.org/10.3233/CH-2012-1538
- Clinical and arteriographic characterization of patients with unstable angina without critical coronary arterial narrowing (from the TIMI-IIIA Trial).Am J Cardiol. 1994; 74: 531-537https://doi.org/10.1016/0002-9149(94)90739-0
- Microvascular angina and the continuing dilemma of chest pain with normal coronary angiograms.J Am Coll Cardiol. 2009; 54: 877-885https://doi.org/10.1016/J.JACC.2009.03.080
- Histologic evidence for small-vessel coronary artery disease in patients with angina pectoris and patent large coronary arteries.Circulation. 1986; 74: 964-972https://doi.org/10.1161/01.CIR.74.5.964
- Slow coronary flow: clinical and histopathological features in patients with otherwise normal epicardial coronary arteries.Cathet Cardiovasc Diagn. 1996; 37: 375-381https://doi.org/10.1002/(SICI)1097-0304(199604)37:4<375::AID-CCD7>3.0.CO;2-8
- Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon.Am Heart J. 2003; 146: 84-90https://doi.org/10.1016/S0002-8703(03)00124-8
- Prognostic impact of coronary microvascular dysfunction in patients with myocardial infarction with non-obstructive coronary arteries.Eur J Intern Med. 2021; 92: 79-85https://doi.org/10.1016/J.EJIM.2021.05.027
- Incidence, predictors, and prognosis of coronary slow-flow and no-reflow phenomenon in patients with chronic total occlusion who underwent percutaneous coronary intervention.Ther Clin Risk Manag. 2020; 16: 95-101https://doi.org/10.2147/TCRM.S233512
- Coronary slow flow: benign or ominous?.Anadolu Kardiyol Derg. 2015; 15: 531-535https://doi.org/10.5152/akd.2014.5578
- Comparison of the outcomes between coronary no-reflow and slow-flow phenomenon in non-STEMI patients.Arq Bras Cardiol. 2021; 116: 856-864https://doi.org/10.36660/ABC.20190905
- What is the prognosis for patients with the coronary slow flow phenomenon?.Hear Lung Circ. 2019; 28: S328-S329https://doi.org/10.1016/J.HLC.2019.06.451
- ST/T wave changes during acute coronary syndrome presentation in patients with the coronary slow flow phenomenon.Int J Cardiol. 2011; 146: 457-458https://doi.org/10.1016/J.IJCARD.2010.10.120
Article info
Publication history
Published online: December 02, 2022
Accepted:
November 21,
2022
Received in revised form:
November 3,
2022
Received:
August 27,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
