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Prognostic stratification of coronary microvascular dysfunction in STEMI patients with or without diabetes mellitus
Yiyue Zheng1,2,3,4, Abudushalamu Shadeerding5, Yuxuan Zhang1,2,3,4
1Department of Cardiology of The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
Insights
Microvascular dysfunction after percutaneous coronary intervention (PCI) predicts adverse events in ST-segment elevation myocardial infarction (STEMI) patients. Combining diabetes mellitus (DM) with high post-PCI microvascular resistance significantly increases major adverse cardiac events (MACE) risk.
Area of Science:
- Cardiology
- Vascular Biology
- Diabetes Research
Background:
- Microvascular dysfunction is a critical factor in ST-segment elevation myocardial infarction (STEMI) prognosis.
- The combined impact of diabetes mellitus (DM) and post-percutaneous coronary intervention (PCI) microvascular dysfunction on STEMI outcomes requires further investigation.
Purpose of the Study:
- To evaluate the relationship between post-PCI microvascular dysfunction, assessed by angiography-derived index of microcirculatory resistance (IMR), and 2-year major adverse cardiac events (MACE) in STEMI patients.
- To determine if diabetes mellitus modifies the impact of post-PCI microvascular dysfunction on MACE.
Main Methods:
- Retrospective analysis of 1,629 STEMI patients who underwent PCI.
- Measurement of post-PCI angiography-derived index of microcirculatory resistance (angio-IMR).
- Assessment of 2-year MACE, including cardiac death, heart failure readmission, myocardial re-infarction, and target vessel revascularization.
Main Results:
- Post-PCI angio-IMR did not significantly differ between patients with and without diabetes.
- Elevated post-PCI angio-IMR (> 40) was associated with significantly higher MACE rates in both diabetic and non-diabetic patients.
- Patients with both diabetes and elevated post-PCI angio-IMR exhibited the highest adjusted hazard ratio for MACE.
Conclusions:
- Post-PCI angio-IMR is an independent predictor of 2-year MACE in STEMI patients, irrespective of diabetes status.
- The combination of diabetes and elevated post-PCI angio-IMR identifies a high-risk subgroup requiring targeted management strategies.
Aim:
This study aims to investigate the interplay between post-percutaneous coronary intervention (PCI) microvascular dysfunction and diabetes mellitus (DM) in patients with ST-segment elevation myocardial infarction (STEMI) and their combined impact on prognosis.
Methods:
This retrospective study included 1,629 STEMI patients who successfully underwent PCI across three centers. Angio-IMR (angiography-derived index of microcirculatory resistance) was retrospectively measured. The primary endpoint was 2-year major adverse cardiac events (MACE), defined as a composite of cardiac death, readmission for heart failure, myocardial re-infarction, and target vessel revascularization.
Result:
Among the 1,629 patients, 448(27.5%) had diabetes. Post-PCI angio-IMR value did not differ significantly between DM and non-DM group (33.04 [interquartile range (IQR) 22.20-43.20] vs. 32.02[IQR 22.57-41.60]; P = 0.420). Patients with post-PCI angio-IMR > 40 had significantly higher rates of MACE, irrespective of diabetes status (DM group: 23.1% vs. 6.7%; P < 0.001. Non-DM group: 19.0% vs. 4.8%; P < 0.001. P for interaction = 0.771). Patients with both diabetes and angio-IMR > 40 had the highest hazard ratio (HR) for MACE after adjustment (HR 5.076; 95% confidence interval, 3.157-8.161; P < 0.001).
Conclusions:
Post-PCI angio-IMR is an independent predictor of 2-year MACE in STEMI patients, regardless of diabetes status. Patients with both diabetes and post-PCI angio-IMR > 40 had the highest 2-year adverse event rates, underscoring the need for targeted risk assessment and management.
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