FFR IN MYOCARDIAL INFARCTION Sample Clauses

FFR IN MYOCARDIAL INFARCTION. There is a general consensus that in the acute phase of myocardial infarction (MI), FFR is neither reliable nor useful to assess the culprit lesions and should be deferred until after stabilisation. The main concern is that of raised microvascular resistance as a consequence of microvascular injury due to thromboemboli, platelet plugging, coronary vasospasm and endothelial dysfunction. There have been a number of studies testing the utility of FFR in the early days after acute myocardial infarction. Xxxxxx et al in one study (58), performed FFR measurements in patients in the infarct related artery early in the days after NSTEMI and STEMI and subsequently did myocardial contrast echocardiography (MCE) and single photon emission computed tomography (SPECT). They demonstrated that early into the infarct, an FFR of <0.75 reliably identified the presence of reversible ischaemia. Xx Xxxxxx et al (57) obtained FFR measurements and SPECT studies before and after PCI in 57 patients 3.7 +/- 1.3 days after infarction also in the infarct related artery. To identify true reversibility, follow-up SPECT was performed 11 weeks after PCI. The sensitivity, specificity, and concordance of FFR ≤ 0.75 for detecting true reversibility on SPECT were 88%, 93%, and 91% (chi-square p < 0.001) and for detecting reversibility on myocardial contrast echo were 90%, 100%, and 93% (chi-square p < 0.001), respectively. The optimal FFR value for discriminating inducible ischaemia on non-invasive imaging was also 0.78, similar to findings by Xxxxxx et al (58). They concluded that that the 0.75 cut-off value of FFR to distinguish patients with positive from patients with negative SPECT imaging is valid after a myocardial infarction and that for a similar degree of stenosis, the value of FFR depends on the mass of viable myocardium. The diagnostic accuracy demonstrated in this study is commendable but correlating an FFR value done early in the days after infarction with a non-invasive imaging test done 11 weeks later does raise questions regarding the validity of the findings. In another study, XxXXxxx et al (99) demonstrated that for angiographic lesions of matched lumen diameter and lesion length, FFR of vessels supplying recently infarcted myocardium is similar to FFR in non-infarcted myocardium in a control population. Additionally, the correlation between percent diameter stenosis and FFR and the slope of correlation is similar in recently infarcted and non-infarcted myocardium. This st...
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