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Published on: January 28, 2020
Long-Term Prognostic Impact of Changes in Coronary Angiography-Derived Index of Microcirculatory Resistance Following
Yuxuan Zhang1, Jiacheng Fang1, Zining Chen1
1Department of Cardiology of The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China; Cardiovascular Key Laboratory Zhejiang Province, Hangzhou, China; Transvascular Implant Instrument Research Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Binjiang District, Hangzhou, China.
Insights
Elevated changes in angiography-derived index of microcirculatory resistance (Δangio-IMR) after percutaneous coronary intervention (PCI) predict higher risks of target vessel failure (TVF). High Δangio-IMR is a valuable indicator for risk stratification in patients with intermediate coronary stenosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Physiology
Background:
- Angiography-derived index of microcirculatory resistance (angio-IMR) assesses coronary microvascular function.
- The prognostic value of changes in angio-IMR (Δangio-IMR) post-intervention is not well-defined.
Purpose of the Study:
- To evaluate the long-term prognostic significance of Δangio-IMR after percutaneous coronary intervention (PCI).
- To assess Δangio-IMR's utility in risk stratifying patients with intermediate coronary stenosis.
Main Methods:
- Analysis of 814 vessels with intermediate coronary stenosis from the FLAVOUR trial undergoing PCI.
- Primary endpoint: target vessel failure (TVF) including cardiac death, target vessel MI, and revascularization.
- Δangio-IMR assessed using the 75th percentile as a cutoff (Δangio-IMR >5).
Main Results:
- High Δangio-IMR (>5) was associated with significantly increased TVF risk (15.62% vs 9.47%, HR 1.82, P=0.011).
- High Δangio-IMR independently predicted TVF (HR 1.72, P=0.034).
- Significant interaction between Δangio-IMR and post-PCI angio-IMR (P=0.028); high Δangio-IMR markedly increased TVF risk when post-PCI angio-IMR was >25 (HR 5.18, P=0.021).
Conclusions:
- Elevated Δangio-IMR following PCI correlates with heightened TVF risk in intermediate coronary stenosis.
- Δangio-IMR serves as a valuable risk stratification tool, especially in patients with high post-PCI angio-IMR.
Background:
Angiography-derived index of microcirculatory resistance (angio-IMR) is a reliable measure for assessing coronary microvascular function. However, the prognostic significance of changes in angio-IMR (Δangio-IMR) remains unclear.
Objectives:
The aim of this study was to assess the long-term prognostic utility of Δangio-IMR following percutaneous coronary intervention (PCI) in patients with intermediate coronary stenosis.
Methods:
A total of 814 vessels with intermediate coronary stenosis that underwent PCI were enrolled from the FLAVOUR (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients with Intermediate Stenosis) trial. The primary endpoint was target vessel failure (TVF) during long-term follow-up, defined as a composite of cardiac death, target vessel-related myocardial reinfarction, and target vessel revascularization.
Results:
The median Δangio-IMR was 2.02 (Q1-Q3: 0.50-5.00). Using the 75th percentile (Δangio-IMR >5) as the cutoff, 203 vessels were assigned to the high Δangio-IMR group. Vessels with high Δangio-IMR demonstrated a significantly elevated risk for TVF compared with those with low Δangio-IMR (15.62% vs 9.47%; HR: 1.82; 95% CI: 1.15-2.88; P = 0.011). High Δangio-IMR independently predicted TVF (HR: 1.72; 95% CI: 1.04-2.83; P = 0.034). There was a notable interaction effect between Δangio-IMR and post-PCI angio-IMR (P = 0.028). A stratified analysis by post-PCI angio-IMR revealed that vessels with high Δangio-IMR showed a markedly increased TVF risk compared with vessels with low Δangio-IMR in those with post-PCI angio-IMR >25 (26.2% vs 11.9%; HR: 5.18; 95% CI: 1.28-20.94; P = 0.021), whereas no such association was observed in those with post-PCI angio-IMR ≤25 (12.6% vs 9.3%; HR: 1.33; 95% CI: 0.77-2.29; P = 0.305).
Conclusions:
An elevated Δangio-IMR correlates with a heightened risk of TVF in vessels with intermediate coronary stenosis underwent PCI. ΔAngio-IMR could be used as a valuable risk stratification indicator, particularly in patients with high post-PCI angio-IMR.
