Impact of TMAO Serum Levels on Hyperemic IMR in STEMI Patients

Study Overview
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Brief Summary
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Trimethylamine N-oxide (TMAO) is a gut microbiota-dependent metabolite of dietary choline, L-carnitine, and phosphatidylcholine-rich foods. On the basis of experimental studies and patients with prevalent disease, elevated plasma TMAO may increase risk of atherosclerotic cardiovascular disease (ASCVD). However, to our knowledge, no data is available on its impact on coronary microcirculation.

Official Title
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Impact of Trimethylamine N-oxide (TMAO) Serum Levels on Index of Microcirculatory Resistance (IMR) in Patients Diagnosed With ST-Elevation Myocardial Infarction (STEMI)

Conditions
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Microvascular Coronary Artery Disease, STEMI - ST Elevation Myocardial Infarction

Intervention / Treatment
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* Procedure: pressure-temperature sensor guidewire-based measurement


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient diagnosed with STEMI Availability of non- left anterior descending artery (LAD) non culprit lesion, which is planned for a staged Percutaneous coronary intervention (PCI) Exclusion Criteria: patient undergoing cardiopulmonary resuscitation; patients with a history of old myocardial infarction or history of coronary artery bypass grafting (CABG) or Percutaneous coronary intervention PCI Patients with signs of chronic infection, prolong usage of corticosteroids or compromised immune system patients had thrombolysis before primary Percutaneous coronary intervention (pPCI) had contraindication of adenosine triphosphate (ATP); had a history of liver or renal function dysfunction Patients with dementia Patients being referred to CABG after primary PCI unable to provide informed consent; had pregnancy or life span < 1 year. Presence of sever structural valvular heart disease Presence of significant left main disease Unability to measure the index of microcirculatory resistance due to (death or retraction from the study ...etc) Inability to perform successful PCI

Ages Eligible for Study
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Minimum Age: 40 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: pressure-temperature sensor guidewire-based measurement|In brief, a 6-F angioplasty guiding catheter without side-holes will be used first used to engage the left main coronary artery. A pressure-temperature sensor guidewire ( PressureWire™ X Guidewire) will be used for physiology measurements including IMR measurements. Pressure measurement from the wire was first equalized with that of the guiding catheter. Then the pressure sensor will be positioned two-thirds of the way down the LAD artery. Intracoronary nitroglycerin will be administered (100 to 200 μg). Hyperemia will be induced with adenosine intracoronary injections.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Index of microcirculatory resistance | The index of microcirculatory resistance (IMR) will be detected using PressureWire™ X Guidewire | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Left ventricular ejection fraction | left ventricular ejection fraction will be assessed via echocardiography imaging using Simpson's biplane method. | 3 months | 
| major adverse cardiovascular events (MACE) | . MACE was defined as follows: cardiovascular death, non-fatal myocardial infarction, target vessel revascularization, recurrent hospitalization due to decompensated heart failure, and stroke (ischemic or hemorrhagic). | up to 1 year |