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Coronary angiography-derived microcirculatory resistance predicts adverse cardiovascular events in elderly with
Kangming Li1,2, Lele Wang3, Panqing Liao1
1Department of Emergency, Guiling People's Hospital, Guilin, China.
Insights
Coronary microvascular dysfunction (CMD) assessment using coronary angiography-derived index of microcirculatory resistance (caIMR) effectively predicts major adverse cardiovascular events (MACE) in elderly patients with unstable angina after percutaneous coronary intervention.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Coronary microvascular dysfunction (CMD) is a key factor in adverse cardiovascular outcomes.
- Coronary angiography-derived index of microcirculatory resistance (caIMR) is a promising noninvasive tool for CMD assessment.
- Prognostic value of caIMR in elderly unstable angina (UA) patients post-percutaneous coronary intervention (PCI) needs further exploration.
Purpose of the Study:
- To evaluate the prognostic value of post-PCI caIMR in elderly UA patients.
- To determine if caIMR can stratify risk for major adverse cardiovascular events (MACE).
Main Methods:
- Retrospective cohort study of 348 elderly UA patients (age ≥65) undergoing PCI.
- Patients stratified by post-PCI caIMR (cutoff 2.50 mmHg s/cm).
- Primary endpoint: MACE (myocardial infarction, stroke, heart failure, angina rehospitalization, cardiovascular death). Multivariable Cox regression and subgroup analyses were performed.
Main Results:
- Elevated caIMR (≥2.50 mmHg s/cm) was associated with significantly higher MACE rates.
- caIMR independently predicted MACE, with diabetes mellitus also showing predictive value.
- caIMR demonstrated consistent prognostic value across subgroups, including those with and without hypertension or diabetes.
Conclusions:
- Noninvasive caIMR assessment is effective in stratifying post-PCI risk in elderly UA patients.
- caIMR serves as a valuable tool for identifying high-risk individuals for targeted interventions.
Background:
Coronary microvascular dysfunction (CMD) has been increasingly recognized as a critical determinant of adverse cardiovascular outcomes. The coronary angiography-derived index of microcirculatory resistance (caIMR) has emerged as a promising noninvasive tool for CMD assessment, yet its prognostic value in elderly patients with unstable angina (UA) following percutaneous coronary intervention (PCI) remains insufficiently explored.
Methods:
This single-center retrospective cohort study enrolled 348 elderly UA patients (age ≥65 years) who underwent PCI between June 2022 and February 2024. Patients were stratified by post-PCI caIMR using a cutoff value of 2.50 mmHg s/cm. The primary endpoint was major adverse cardiovascular events (MACE), including myocardial infarction, stroke, heart failure, angina rehospitalization, and cardiovascular death. Multivariable Cox regression and subgroup analyses were performed to evaluate the prognostic consistency of caIMR across different patient characteristics.
Results:
Patients with caIMR ≥2.50 mmHg s/cm demonstrated significantly higher MACE rates. Multivariable analysis confirmed caIMR as an independent predictor, with diabetes mellitus also showing predictive value. Subgroup analyses revealed consistent prognostic value of caIMR regardless of hypertension status or diabetes.
Conclusion:
Noninvasive caIMR assessment effectively stratifies post-PCI risk in elderly UA patients.
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