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Prognostic Value of Coronary Microvascular Dysfunction Assessed by Coronary Angiography-Derived Index of
Han Chao1, Gao Jun-Qing1, Zhang Hong1
1Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Insights
Coronary angiography-derived microvascular resistance (CaIMR) effectively predicts adverse outcomes in ST-elevation myocardial infarction (STEMI) patients. Higher CaIMR values indicate increased risk, aiding in objective risk stratification.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Physiology
Background:
- Coronary angiography-derived microvascular resistance (CaIMR) is a novel index for assessing coronary microcirculation.
- CaIMR offers an alternative to pressure wires and hyperemic agents for microvascular assessment.
- The prognostic value of CaIMR in ST-elevation myocardial infarction (STEMI) requires further investigation.
Purpose of the Study:
- To evaluate the impact of CaIMR on predicting clinical outcomes in STEMI patients.
- To assess the correlation between CaIMR and the occurrence of major adverse cardiovascular events (MACE).
- To identify risk factors associated with MACE in STEMI patients.
Main Methods:
- A cohort of 140 STEMI patients undergoing percutaneous coronary intervention (PCI) were categorized based on CaIMR values.
- Baseline characteristics, laboratory data, and 12-month MACE were collected.
- Multivariate Cox regression and logistic regression models were employed for risk factor analysis.
Main Results:
- Patients with coronary microvascular dysfunction (CMD) identified by CaIMR had a significantly higher risk of MACE compared to non-CMD.
- CaIMR was a significant independent predictor of prognosis in STEMI patients (HR: 8.921).
- Culprit vascular CMD was associated with increased incidence of MACE (OR: 4.75) and heart failure (OR: 7.50).
Conclusions:
- CaIMR serves as a potent predictor of clinical outcomes in STEMI.
- CaIMR facilitates objective risk stratification for STEMI patients.
- Leukocyte index, furosemide use, and Killip classification correlate with clinical outcomes in this cohort.
Background:
CaIMR is proposed as a novel angiographic index designed to assess microcirculation without the need for pressure wires or hyperemic agents. We aimed to investigate the impact of caIMR on predicting clinical outcomes in STEMI patients.
Methods:
One hundred and forty patients with STEMI who received PCI in Putuo Hospital of Shanghai from October 2021 to September 2022 were categorized into CMD and non-CMD groups according to the caIMR value. The baseline information, patient-related examinations, and the occurrence of MACE at the 12-month follow-up were collected to investigate risk factors in patients with STEMI.
Results:
We divided 140 patients with STEMI enrolled into two groups according to caIMR results, including 61 patients diagnosed with CMD and 79 patients diagnosed with non-CMD. A total of 21 MACE occurred during the 1 year of follow-up. Compared with non-CMD group, patients with CMD showed a significantly higher risk of MACE. A multivariate Cox regression model was conducted for the patients, and it was found thatcaIMR was a significant predictor of prognosis in STEMI patients (HR: 8.921). Patients with CMD were divided into culprit vascular CMD and non-culprit vascular CMD, and the result found that culprit vascular CMD was associated with the incidence of MACE (OR: 4.75) and heart failure (OR: 7.50).
Conclusion:
CaIMR is a strong predictor of clinical outcomes and can provide an objective risk stratification for patients with STEMI. There is a strong correlation among leukocyte index, the use of furosemide, Killips classification, and clinical outcomes.
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