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Coronary microvascular dysfunction mediates in-hospital adverse outcomes in ST-segment elevation myocardial

Guoli Yao1, Mengru Guo1, Na Song1

  • 1Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.

Frontiers in Cardiovascular Medicine
|May 4, 2026
PubMed

Insights

Patients with ST-segment elevation myocardial infarction (STEMI) lacking cardiovascular risk factors had worse outcomes. Coronary microvascular dysfunction (CMVD) partially explained this association, highlighting its role in STEMI prognosis.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Biomedical Engineering

Background:

  • ST-segment elevation myocardial infarction (STEMI) patients without standard modifiable cardiovascular risk factors (SMuRF-less) exhibit poorer in-hospital outcomes compared to those with risk factors (SMuRFs).
  • The contribution of coronary microvascular dysfunction (CMVD) to this disparity remains incompletely understood.

Purpose of the Study:

  • To determine if CMVD mediates the relationship between SMuRF-less status and in-hospital major adverse cardiovascular events (MACE).

Main Methods:

  • 1,027 STEMI patients undergoing percutaneous coronary intervention (PCI) were analyzed.
  • Patients were categorized into SMuRFs (n=806) and SMuRF-less (n=221) groups.
  • Mediation analysis assessed the role of post-procedural coronary angiography-derived index of microcirculatory resistance (caIMR) in linking SMuRF-less status to MACE.

Main Results:

  • The SMuRF-less group had a significantly higher incidence of in-hospital MACE (15.3% vs. 7.0%, P < 0.001).
  • Post-procedural caIMR partially mediated the association between SMuRF-less status and increased MACE risk (β=0.284, 95% CI: 0.101-0.498) after confounder adjustment.

Conclusions:

  • Elevated post-procedural caIMR, a marker of CMVD, independently predicts in-hospital MACE in STEMI patients.
  • CMVD partially mediates the adverse outcomes observed in SMuRF-less STEMI patients, underscoring its clinical significance.
Abstract

Keywords:
ST-segment elevation myocardial infarctioncoronary angiography-derived index of microcirculatory resistancecoronary microvascular dysfunctionmediation analysisstandard modifiable cardiovascular disease risk factors

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