982 NON CULPRIT LESION IN ACS PATIENTS DISCREPANCY BETWEEN HYPERAEMIC AND RESTING INDEXES


 
 
 Multivessel disease occurs in approximately half of patients presenting with STEMI and the best management non-culprit lesions is still unclear. The case reported a patient with inferior STEMI, in which the non-culprit lesion has been evaluated with a “full-physiology” approach by a pressure wire.
 
 
 
 A 52-year-old woman with a history of hypertension and diabetes was admitted to our center diagnosed with inferior STEMI. Coronary angiography showed a thrombotic occlusion (TIMI 0) of the right coronary artery (culprit lesion) and intermediate stenosis of proximal left anterior descending (LAD). Primary PCI (p-PCI) of the right coronary artery has been performed. After 4 days a stepwise complete physiological approach on the LAD artery has been performed. The physiological study showed a negative discrepancy between FFR - and RFR + with increased index of microvascular resistance (IMR).
 
 
 
 The fractional flow reserve (FFR) represents the best-known invasive method for the
 functional evaluation of intermediate coronary stenosis. Unlike the FFR, the resting flow ratio RFR is a non-hyperemic index that does not require the administration of a vasodilator such as adenosine as does the iwFR. There are many factors that can lead to a negative discrepancy between hyperemic and non-hyperemic indices. In the case presented, the functional values found were: FFR: 0.90 RFR: 0.86 and IMR = 76; CFR = 1.0. The FFR-/ RFR+ disagreement may reflect the attenuating influence of microvascular disease on adenosine-mediated vasodilation. Therefore, we decided to treat the LAD lesion according the RFR value with a DES 3.0×33 mm implantation.
 
 
 
 Myocardial infarction can result in altered microvascular and endothelial dysfunction also in the non-culprit territory. The FFR - / RFR + disagreement may reflect the attenuating influence of microvascular disease on adenosine-mediated vasodilation.
