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

J Am Coll Cardiol. 2023 Oct 24;82(17):1676-1687. doi: 10.1016/j.jacc.2023.08.020. Epub 2023 Sep 29.

Abstract

Background: 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.

Objectives: The goal of this study was to evaluate the presence and characteristics of CAD among patients with T2MI.

Methods: 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.

Results: 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%).

Conclusions: 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).

Keywords: coronary computed tomography angiography; fractional flow reserve; type 2 myocardial infarction.

Publication types

  • Clinical Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anterior Wall Myocardial Infarction*
  • Computed Tomography Angiography
  • Constriction, Pathologic
  • Coronary Angiography / methods
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / epidemiology
  • Coronary Stenosis*
  • Female
  • Fractional Flow Reserve, Myocardial* / physiology
  • Humans
  • 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

Associated data

  • ClinicalTrials.gov/NCT04864119