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Prognostic Value of Angiography-Derived Index of Microcirculatory Resistance in Patients with Coronary Artery Disease
Bo Wang1, Yue Gao2, Yifan Zhao1
1Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072 Shanghai, China.
Insights
In patients with coronary artery disease undergoing rotational atherectomy, a high index of microcirculatory resistance (angio-IMR) > 25 predicts major adverse cardiovascular events and target vessel revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Rotational atherectomy (RA) is crucial for treating severe coronary calcification in coronary artery disease (CAD).
- The link between coronary microvascular dysfunction and RA outcomes is not well understood.
- This study investigates the predictive value of the coronary angiography-derived index of microcirculatory resistance (angio-IMR) in CAD patients undergoing RA.
Purpose of the Study:
- To assess the prognostic implications of angio-IMR in patients with severe coronary calcification undergoing RA.
- To determine if angio-IMR can predict major adverse cardiovascular events (MACEs) and target vessel revascularization (TVR) after RA.
- To explore the relationship between coronary microvascular function and outcomes in this patient population.
Main Methods:
- Retrospective analysis of 118 patients with severe coronary calcification who underwent successful RA.
- Calculation of angio-IMR using computed flow and pressure dynamics to evaluate coronary microcirculatory function.
- Follow-up for MACEs (all-cause death, myocardial infarction, TVR, stroke) and analysis using Kaplan-Meier and COX regression.
Main Results:
- The mean angio-IMR was 25.58 ± 7.93; 45.8% of patients had angio-IMR > 25.
- Patients with angio-IMR > 25 experienced significantly higher cumulative MACEs (41.6%) and TVR (20.7%).
- Angio-IMR > 25 and reduced left ventricular ejection fraction were independent predictors of MACEs; angio-IMR > 25 and lower minimum luminal area predicted TVR.
Conclusions:
- A high angio-IMR (> 25) is an independent predictor of MACEs and TVR in CAD patients treated with RA.
- Coronary microvascular dysfunction, as indicated by angio-IMR, plays a significant role in the outcomes of RA.
- The findings highlight the importance of assessing microcirculatory resistance in guiding treatment and predicting prognosis in complex CAD cases.
Background:
Rotational atherectomy (RA) is the major tool used to treat severely calcified lesions in patients with coronary artery disease (CAD). The relationship between coronary microvascular dysfunction and RA remains unknown. Therefore, we attempted to explore the predictive implications of the coronary angiography-derived index of microcirculatory resistance (angio-IMR) in CAD patients undergoing RA.
Methods:
This retrospective study included 118 patients with severe coronary calcification who underwent a successful RA from January 2018 to June 2021. The angio-IMR was calculated based on computed flow and pressure dynamic principles to assess coronary microcirculatory function. Follow-up was performed on all patients for major adverse cardiovascular events (MACEs), including all-cause death, non-fatal myocardial infarction, target vessel revascularization (TVR), and stroke.
Results:
The mean angio-IMR for all patients was 25.58 7.93. Patients were stratified the groups based on a mean angio-IMR of 25, fifty-four (45.8%) patients had angio-IMR 25. The logistic regression analysis showed that angiography-derived fractional flow reserve was significantly associated with coronary microvascular dysfunction. After median follow-up of 21.7 (15.1-24.0) months, MACEs occurred in 30.6%, including 12.5% all-cause deaths, 6.4% non-fatal myocardial infarction, 14.5% TVR, and 0.9% stroke. Kaplan-Meier analysis demonstrated that patients with angio-IMR 25 had greater cumulative MACEs (41.6%) and TVR (20.7%) than patients with preserved angio-IMR. COX regression analysis indicated that angio-IMR 25 and reduced left ventricular ejection fraction were independent predictors of MACEs. In addition, angio-IMR 25 and lowered minimum luminal area independently predicted TVR occurrence.
Conclusions:
In CAD patients undergoing RA, angio-IMR 25 was an independent and significant predictor of MACEs and TVR.
Clinical Trial Registration:
NCT05435898.
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