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Dynamic Changes and Prognostic Value of Angio-derived Index of Microcirculatory Resistance in Acute Myocardial
Jingpu Wang1, Wei Gao1, Zhe Wang2
1Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China; Clinical Research Center for Interventional Medicine, Shanghai, China; State Key Laboratory of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Ischemia Heart Disease, Shanghai, China; Key Laboratory of Viral Heart Disease, Chinese Academy of Medical Science, Shanghai, China.
Insights
High post-PCI index of microcirculatory resistance (IMR) predicts long-term risks after acute myocardial infarction. Elevated angio-IMR >40 indicates increased chances of target vessel failure and heart failure readmission.
Area of Science:
- Cardiology
- Interventional Cardiology
- Microvascular Function
Background:
- Long-term outcomes after acute myocardial infarction (AMI) remain a concern despite improved in-hospital survival.
- Coronary angiography-derived index of microcirculatory resistance (angio-IMR) is a functional parameter assessed after percutaneous coronary intervention (PCI).
Purpose of the Study:
- To dynamically assess angio-IMR after primary PCI in AMI patients.
- To investigate the association between post-PCI angio-IMR and long-term target vessel-related events and clinical prognosis.
Main Methods:
- Retrospective cohort study of 108 AMI patients with 3- and 12-month follow-up coronary angiography.
- Patients were stratified based on post-PCI angio-IMR values.
- Median follow-up of 97 months.
Main Results:
- Immediately post-PCI, angio-IMR was significantly higher in infarct-related arteries (IRAs) compared to non-IRAs (40.16 vs. 20.53, p < 0.001).
- Angio-IMR in IRAs decreased over follow-up, while remaining normal in non-IRAs.
- Post-PCI angio-IMR >40 was independently associated with higher risks of target vessel failure (adjusted HR=3.44) and heart failure readmission (adjusted HR=4.74).
Conclusions:
- A post-procedural angio-IMR >40 is an independent predictor of long-term target vessel failure and heart failure readmission after primary PCI for AMI.
- Angio-IMR shows potential as a prognostic marker for early risk stratification.
- Findings support individualized secondary prevention strategies based on microcirculatory resistance.
Background:
Despite improved in-hospital mortality for acute myocardial infarction (AMI), long-term outcomes remain concerning. This study used angiography-derived functional parameters to dynamically assess coronary angiography-derived index of microcirculatory resistance (angio-IMR) after primary percutaneous coronary intervention (PCI) and investigate its association with target vessel-related events and clinical prognosis.
Methods:
This retrospective cohort study included 108 AMI patients who completed 3- and 12-month follow-up coronary angiography. Patients were stratified according to a post PCI angio-IMR value.
Results:
Immediately after primary PCI, angio-IMR values were substantially higher in infarct-related arteries (IRAs) compared with non-IRAs (40.16 ± 10.41 vs 20.53 ± 9.18; P < 0.001). Over the follow-up period, angio-IMR in IRAs progressively decreased, whereas it remained normal in non-IRAs. Consequently, the absolute difference in angio-IMR between these vessel types (defined as IRAs minus non-IRAs) diminished sequentially (post PCI: 19.6; 3-month: 2.4; 12-month: -1.1). During a median 97-month follow-up, angio-IMR > 40 was associated with significantly higher risks of target vessel failure (hazard ratio [HR], 2.57; 95% confidence interval [CI], 1.20-5.52; P = 0.015), and heart failure readmission (subdistribution HR, 2.27; 95% CI, 1.06-4.48, P = 0.034). Multivariable analysis confirmed post-PCI angio-IMR > 40 (adjusted HR, 3.44; 95% CI, 1.35-8.77; P = 0.010) and persistent angio-IMR elevation (adjusted HR, 4.74; 95% CI, 1.68-13.37; P = 0.003) as independent predictors of target vessel failure.
Conclusions:
Postprocedural angio-IMR > 40 independently predicted long-term target vessel failure and heart failure readmission after successful primary PCI for AMI, highlighting its potential as a promising prognostic marker for early risk stratification and individualized secondary prevention.
