Coronary Computed Tomographic Angiography With Fractional Flow Reserve in Patients With Type 2 Myocardial Infarction
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 abou...
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| Published in | Journal of the American College of Cardiology Vol. 82; no. 17; pp. 1676 - 1687 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
24.10.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0735-1097 1558-3597 1558-3597 |
| DOI | 10.1016/j.jacc.2023.08.020 |
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| Abstract | 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)
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| AbstractList | 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] 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.BACKGROUNDType 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.OBJECTIVESThe 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.METHODSIn 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%).RESULTSAmong 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).CONCLUSIONSAmong 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). AbstractBackgroundType 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. ObjectivesThe goal of this study was to evaluate the presence and characteristics of CAD among patients with T2MI. MethodsIn 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 (FFR CT), and plaque volume analyses. ResultsAmong 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 FFR CT was present in 13 participants (26%). Among participants with a stenosis ≥50% (n = 21), FFR CT excluded lesion-specific hemodynamically significant stenosis in 8 cases (38%). ConclusionsAmong 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) 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 (FFR ), 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 FFR was present in 13 participants (26%). Among participants with a stenosis ≥50% (n = 21), FFR 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). |
| Author | Levin, Allison Blankstein, Ron Rogers, Campbell Murphy, Sean P. Hedgire, Sandeep Januzzi, James L. Miksenas, Hannah Lin, Claire Rambarat, Paula K. Amponsah, Daniel K. Wasfy, Jason H. Mohebi, Reza Ghoshhajra, Brian McCarthy, Cian P. Liu, Yuxi Raghavan, Avanthi |
| Author_xml | – sequence: 1 givenname: Cian P. surname: McCarthy fullname: McCarthy, Cian P. organization: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA – sequence: 2 givenname: Sean P. surname: Murphy fullname: Murphy, Sean P. organization: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA – sequence: 3 givenname: Daniel K. surname: Amponsah fullname: Amponsah, Daniel K. organization: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA – sequence: 4 givenname: Paula K. surname: Rambarat fullname: Rambarat, Paula K. organization: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA – sequence: 5 givenname: Claire surname: Lin fullname: Lin, Claire organization: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA – sequence: 6 givenname: Yuxi surname: Liu fullname: Liu, Yuxi organization: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA – sequence: 7 givenname: Reza surname: Mohebi fullname: Mohebi, Reza organization: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA – sequence: 8 givenname: Allison surname: Levin fullname: Levin, Allison organization: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA – sequence: 9 givenname: Avanthi surname: Raghavan fullname: Raghavan, Avanthi organization: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA – sequence: 10 givenname: Hannah surname: Miksenas fullname: Miksenas, Hannah organization: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA – sequence: 11 givenname: Campbell surname: Rogers fullname: Rogers, Campbell organization: HeartFlow Inc, Mountain View, California, USA – sequence: 12 givenname: Jason H. surname: Wasfy fullname: Wasfy, Jason H. organization: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA – sequence: 13 givenname: Ron surname: Blankstein fullname: Blankstein, Ron organization: Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA – sequence: 14 givenname: Brian orcidid: 0000-0002-3865-3432 surname: Ghoshhajra fullname: Ghoshhajra, Brian organization: Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA – sequence: 15 givenname: Sandeep surname: Hedgire fullname: Hedgire, Sandeep organization: Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA – sequence: 16 givenname: James L. surname: Januzzi fullname: Januzzi, James L. email: jjanuzzi@mgh.harvard.edu organization: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA |
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| CitedBy_id | crossref_primary_10_1093_eurheartj_ehae803 crossref_primary_10_1016_j_jacadv_2025_101629 crossref_primary_10_1016_j_jacc_2023_08_021 crossref_primary_10_1016_j_jacc_2024_01_001 crossref_primary_10_1016_j_jacadv_2023_100788 |
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| Keywords | 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 |
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| Snippet | Type 2 myocardial infarction (T2MI) related to a supply/demand imbalance of coronary blood flow is common and associated with poor prognosis. Coronary artery... AbstractBackgroundType 2 myocardial infarction (T2MI) related to a supply/demand imbalance of coronary blood flow is common and associated with poor prognosis.... |
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| SubjectTerms | 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 |
| Title | Coronary Computed Tomographic Angiography With Fractional Flow Reserve in Patients With Type 2 Myocardial Infarction |
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