Increased Thrombogenicity is Associated With Coronary Microvascular Dysfunction in Patients With STEMI-A Proof-of-Concept Study

Roberto Scarsini; Denis Leonardi; Andrea Bottardi; Concetta Mammone; Leonardo Portolan; Caterina Butturini; Verdiana Galli; Francesco Della Mora; Alessandro Ruzzarin; Sara Pazzi; Anna Piccoli; Simone Fezzi; Domenico Tavella; Gabriele Pesarini; Leonardo Gottin; Flavio Ribichini

doi:10.1002/ccd.31612

Increased Thrombogenicity is Associated With Coronary Microvascular Dysfunction in Patients With STEMI-A Proof-of-Concept Study

Catheter Cardiovasc Interv. 2025 May 27. doi: 10.1002/ccd.31612. Online ahead of print.

Authors

Roberto Scarsini¹, Denis Leonardi¹, Andrea Bottardi¹, Concetta Mammone¹, Leonardo Portolan¹, Caterina Butturini¹, Verdiana Galli^{1

2}, Francesco Della Mora¹, Alessandro Ruzzarin¹, Sara Pazzi¹, Anna Piccoli¹, Simone Fezzi¹, Domenico Tavella¹, Gabriele Pesarini¹, Leonardo Gottin³, Flavio Ribichini¹

Affiliations

¹ Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy.
² Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.
³ Department of Surgery, Division of Anesthesia and Intensive Care Unit for Cardiac and Thoracic Surgery, University of Verona, Verona, Italy.

PMID: 40421631
DOI: 10.1002/ccd.31612

Abstract

Background: Up to 50% of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) develop coronary microvascular dysfunction (CMD).

Aims: This study aims to assess whether a prothrombotic state of coronary blood, defined by thromboelastography (TEG), is associated with post-pPCI CMD in STEMI.

Methods: TEG analysis of infarct-related coronary artery (IRA) blood was performed in 25 consecutive STEMI patients before and after successful pPCI. CMD was defined by high values of the angiography-derived index of microcirculatory resistance (IMR_angio ≥ 40 units).

Results: The median age was 59 (IQR 51-71) years. CMD was observed in 13 (52%) patients. Pre-pPCI Reaction (R) and Kinetic (K) time of the coronary blood from the IRA were inversely correlated with IMR_angio (rho -0.45, p = 0.02; rho -0.62, p = 0.002 respectively). R time was significantly shorter in patients who developed CMD (10.7 [IQR 8.8, 13.1] vs. 18.2 [IQR 12.6, 24.2], p = 0.05), and it provided an overall good diagnostic accuracy in predicting CMD (AUC 0.75, [95% CI 0.53-0.96] p = 0.05). Similar relationship was founded for K time: 3.5 [IQR 2.2-4.6] versus 10.6 [IQR 4.5-30.0] min, p = 0.01; AUC 0.82, [95% CI 0.64-0.99] p = 0.01. Moreover, α angle was significantly larger (57.4 [IQR 46.5-64.8] vs. 40.0 [IQR 39.0-49.5], p = 0.03) in patients with CMD (AUC 0.78, [95% CI 0.57-0.98], p = 0.03). Coronary post-pPCI TEG parameters were not associated with CMD.

Conclusions: In this proof-of-concept study, a prothrombotic state of coronary blood from the IRA is associated with CMD. Further studies are warranted to evaluate if TEG may enhance individualized therapies in patients with STEMI at risk of CMD.

Keywords: ST‐elevation myocardial infarction; angiography‐derived index of microcirculatory resistance; coronary microvascular dysfunction; microvascular obstruction; thromboelastography.