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Prognostic value of angiographic microvascular resistance in patients with ST-segment elevation myocardial infarction

Gangzhen Qian1, Haoran Qin1, Dan Deng1

  • 1Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University, Chongqing, China.

Clinics (Sao Paulo, Brazil)
|July 25, 2024
PubMed
Abstract

Insights

Angiographic Microvascular Resistance (AMR) measured after percutaneous coronary intervention predicts adverse outcomes in ST-segment elevation myocardial infarction (STEMI) patients. AMR-based nomograms enhance risk prediction for mortality or heart failure readmission.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Research

Background:

  • ST-segment elevation myocardial infarction (STEMI) management relies on reperfusion therapies.
  • Index of Microcirculatory Resistance (IMR) assesses microvascular function but requires specific tools.
  • Angiographic Microvascular Resistance (AMR) offers a potential alternative using standard angiography.

Purpose of the Study:

  • To evaluate the prognostic significance of Angiographic Microvascular Resistance (AMR) in STEMI patients post-primary Percutaneous Coronary Intervention (PCI).
  • To determine if AMR can predict adverse cardiovascular outcomes, specifically all-cause mortality or heart failure readmission.

Main Methods:

  • Retrospective analysis of 232 STEMI patients undergoing primary PCI.
  • Patients categorized into high and low AMR groups based on a threshold of 2.55 mmHg*s/cm.
  • Composite endpoint: all-cause mortality or heart failure readmission, assessed via maximally selected log-rank statistics.

Main Results:

  • Higher AMR group showed significantly increased risk for the composite endpoint (HRadj: 3.33; p=0.03).
  • AMR ≥ 2.55 mmHg*s/cm independently predicted the composite endpoint (HR: 2.33; p=0.04).
  • A nomogram including AMR, age, sex, LVEF, and post-PCI QFR improved 3-year risk prediction for STEMI patients.

Conclusions:

  • AMR measurement post-PCI is a valuable prognostic tool for STEMI patients.
  • AMR predicts the risk of all-cause death and heart failure readmission.
  • AMR-integrated nomograms enhance the predictive accuracy for adverse outcomes in STEMI.
Keywords:
AMRCoronary angiographyCoronary physiologyPrognosisST-segment elevation myocardial infarction

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