Coronary Computed Tomographic Angiography With Fractional Flow Reserve in Patients With Type 2 Myocardial Infarction

• Published in: Journal of the American College of Cardiology Vol. 82; no. 17; pp. 1676 - 1687
• Main Authors: McCarthy, Cian P., Murphy, Sean P., Amponsah, Daniel K., Rambarat, Paula K., Lin, Claire, Liu, Yuxi, Mohebi, Reza, Levin, Allison, Raghavan, Avanthi, Miksenas, Hannah, Rogers, Campbell, Wasfy, Jason H., Blankstein, Ron, Ghoshhajra, Brian, Hedgire, Sandeep, Januzzi, James L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 24.10.2023
• Subjects: Aged; Anterior Wall Myocardial Infarction; Cardiovascular; Computed Tomography Angiography; Constriction, Pathologic; Coronary Angiography - methods; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; coronary computed tomography angiography; Coronary Stenosis; Female; fractional flow reserve; Fractional Flow Reserve, Myocardial - physiology; Humans; Internal Medicine; Male; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - epidemiology; Plaque, Atherosclerotic - complications; Plaque, Atherosclerotic - diagnostic imaging; Plaque, Atherosclerotic - epidemiology; Predictive Value of Tests; Prospective Studies; Tomography, X-Ray Computed; type 2 myocardial infarction; coronary computed tomography angiography; CAC; CAD; CTA; hs-cTnT; V/M; type 2 myocardial infarction; PCI; FFRCT; hs-cTn; CABG; MI; T2MI; fractional flow reserve; T1MI; coronary artery disease; coronary artery calcium; myocardial infarction; FFR CT; fractional flow reserve derived with coronary computed tomography angiography; total epicardial coronary artery lumen volume to left ventricular myocardial mass; percutaneous coronary intervention; high-sensitivity cardiac troponin T; high-sensitivity cardiac troponin; coronary artery bypass grafting; computed tomography angiography; type 1 myocardial infarction
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2023.08.020

Type 2 myocardial infarction (T2MI) related to a supply/demand imbalance of coronary blood flow is common and associated with poor prognosis. Coronary artery disease (CAD) may predispose some individuals to T2MI and contribute to its high rate of recurrent cardiovascular events. Little is known about the presence and extent of CAD in this population. The goal of this study was to evaluate the presence and characteristics of CAD among patients with T2MI. In this prospective study, consecutive eligible individuals with Fourth Universal Definition of Myocardial Infarction criteria for T2MI were enrolled. Participants underwent coronary computed tomography angiography (CTA), fractional flow reserve derived with coronary CTA (FFRCT), and plaque volume analyses. Among 50 participants, 25 (50%) were female, and the mean age was 68.0 ± 11.4 years. Atherosclerotic risk factors were common. Coronary CTA revealed coronary plaque in 46 participants (92%). A moderate or greater stenosis (≥50%) was identified in 42% of participants, and obstructive disease (≥50% left main stenosis or ≥70% stenosis in any other epicardial coronary artery) was present in 26%. Prevalence of obstructive CAD did not differ according to T2MI cause (P = 0.54). A hemodynamically significant focal stenosis identified by FFRCT was present in 13 participants (26%). Among participants with a stenosis ≥50% (n = 21), FFRCT excluded lesion-specific hemodynamically significant stenosis in 8 cases (38%). Among individuals with adjudicated T2MI, CAD was prevalent, but the majority of patients had nonobstructive CAD. Mediators of ischemia are likely multifactorial in this population. (Defining the Prevalence and Characteristics of Coronary Artery Disease Among Patients with Type 2 Myocardial Infarction using CT-FFR [DEFINE TYPE 2 MI]; NCT04864119) [Display omitted]