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Integrating angio-IMR and CMR-assessed microvascular obstruction for improved risk stratification of STEMI patients

Yang Duan1,2, Qianran Yin1,2, Yinshuang Yang3

  • 1Department of Cardiology, The Fourth Affiliated Hospital of Soochow University, 9#, Chongwen Road, Suzhou, 215000, China.

Scientific Reports
|February 14, 2025
PubMed

Insights

Early detection of coronary microvascular dysfunction (CMD) after myocardial infarction is improved by combining computational pressure-fluid dynamics (CPFD) derived index of microcirculatory resistance (caIMR) with cardiac magnetic resonance (CMR) imaging for microvascular obstruction (MVO) assessment.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Diagnostic Imaging

Background:

  • Early detection of coronary microvascular dysfunction (CMD) in ST-segment elevation myocardial infarction (STEMI) patients post-percutaneous coronary intervention (PCI) remains a clinical challenge.
  • Computational pressure-fluid dynamics (CPFD) derived index of microcirculatory resistance (caIMR) offers a practical method for assessing CMD using routine coronary angiography.
  • The combined prognostic value of caIMR and cardiac magnetic resonance (CMR) imaging-identified microvascular obstruction (MVO) in STEMI patients is not well-established.

Purpose of the Study:

  • To investigate the predictive utility of CPFD-caIMR and CMR-derived MVO for major adverse cardiovascular events (MACEs) in STEMI patients undergoing primary PCI.
  • To evaluate the incremental prognostic information gained by combining caIMR and MVO assessments.

Main Methods:

  • Retrospective analysis of 292 STEMI patients who underwent primary PCI, followed by caIMR and CMR evaluations.
  • Patients were stratified based on caIMR thresholds (>40 U vs. ≤40 U) and the presence or absence of MVO.
  • MACEs were defined as cardiac death, recurrent myocardial infarction, target vessel revascularization, or heart failure readmission.

Main Results:

  • Both elevated caIMR (>40 U) and the presence of MVO were identified as independent predictors of MACEs.
  • A hazard ratio of 3.572 was observed for each unit increase in CPFD-caIMR >40 U, indicating significant risk.
  • The combination of CPFD-caIMR and CMR-derived MVO demonstrated significantly enhanced predictive accuracy for MACEs.

Conclusions:

  • CPFD-caIMR is a reliable and minimally invasive tool for identifying microvascular dysfunction in STEMI patients.
  • Integrating CPFD-caIMR with CMR-derived MVO significantly improves risk stratification following PCI.
  • This combined approach holds promise for early identification of high-risk patients, enabling personalized management strategies.

Keywords:
Computational pressure-fluid dynamicsMajor adverse cardiovascular eventsMicrocirculatory obstructionMicrocirculatory resistancePrimary percutaneous coronary interventionST-segment elevation myocardial infarction

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