Angiography-Derived Microcirculatory Resistance in Detecting Microvascular Obstruction and Predicting Heart Failure...

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Interventional Cardiology

Background:

• Microvascular obstruction (MVO) is a known complication of ST-segment-elevation myocardial infarction (STEMI) that contributes to heart failure (HF).
• Assessing microvascular function early is crucial for patient outcomes.
• Angiography-derived microcirculatory resistance (AMR) offers a novel, wire- and adenosine-free method for evaluating microvascular function post-intervention.

Purpose of the Study:

• To evaluate the diagnostic capability of AMR in detecting MVO.
• To assess the prognostic value of AMR for predicting new-onset HF in STEMI patients undergoing primary percutaneous coronary intervention (PCI).

Main Methods:

• Retrospective review of 475 STEMI patients who underwent primary PCI and cardiac magnetic resonance (CMR) between April 2016 and February 2023.
• AMR was calculated from coronary angiography data.
• MVO was identified and quantified using CMR; new-onset HF was the primary endpoint during follow-up.

Main Results:

• AMR demonstrated good performance in detecting MVO, with an area under the curve of 0.821 and an optimal cutoff of 2.7 mm Hg*s/cm.
• During a median follow-up of 37.3 months, 25.5% of patients developed HF.
• AMR was an independent predictor of HF, both as a continuous and categorical variable, even after adjusting for traditional risk factors and CMR parameters. It significantly improved prognostication.

Conclusions:

• AMR is a valuable tool for diagnosing MVO in STEMI patients post-PCI.
• AMR serves as an independent and incremental predictor of HF, enhancing risk stratification beyond conventional methods.