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Angiography-Derived Index of Microvascular Resistance in Patients With Anterior ST-Segment Elevation Myocardial

Ciro Pollio Benvenuto1, Domenico Galante2, Frederik Zimmermann3

  • 1Università Cattolica del Sacro Cuore, Rome, Italy; St Antonius Ziekenhuis, Nieuwegein, Netherlands.

The American Journal of Cardiology
|January 2, 2026
PubMed

Insights

A new angiography-derived Index of Microcirculatory Resistance (AngioIMR) shows promise for predicting adverse outcomes in ST-segment elevation myocardial infarction (STEMI) patients post-primary percutaneous coronary intervention (pPCI). An AngioIMR of 43 or higher indicates a significantly increased risk of major adverse cardiac events.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Research

Background:

  • Microvascular dysfunction is a key factor in adverse outcomes for ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (pPCI).
  • The invasive Index of Microcirculatory Resistance (IMR) is prognostic but limited by its reliance on thermodilution.
  • Angiography-derived indices offer a potential non-invasive alternative for assessing microvascular function.

Purpose of the Study:

  • To evaluate the prognostic performance of the angiography-derived Index of Microcirculatory Resistance (AngioIMR) in STEMI patients undergoing pPCI.
  • To determine if AngioIMR can effectively stratify risk for adverse cardiovascular outcomes.

Main Methods:

  • Retrospective analysis of 180 consecutive STEMI patients undergoing pPCI.
  • Calculation of AngioIMR using the formula: AngioIMR = MAP × QFR × TFC.
  • Assessment of a composite primary endpoint (all-cause death, target vessel MI, heart failure hospitalization) and a secondary endpoint (including angina hospitalization) over a 5-year follow-up.

Main Results:

  • An optimal AngioIMR cut-off of 43 was identified (AUC 0.800).
  • Patients with AngioIMR ≥ 43 had significantly higher rates of primary (18.9% vs. 1.9%) and secondary (28.4% vs. 1.9%) endpoints (p < 0.001).
  • AngioIMR ≥ 43 was an independent predictor of adverse outcomes (HR: 9.5; p < 0.001).

Conclusions:

  • AngioIMR is a promising, non-invasive tool for assessing microvascular function in STEMI patients.
  • AngioIMR can effectively stratify prognosis and identify patients at high risk for adverse cardiovascular events after pPCI.
  • Routine use of AngioIMR could improve risk stratification and patient management in STEMI care.

Keywords:
Coronary Microvascular DysfunctionFunctional Coronary AngiographyIndex of Microcirculatory ResistanceMyocardial InfarctionPercutaneous Coronary InterventionQuantitative Flow Ratio

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