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Elevated angiography-derived microvascular resistance and HbA1c levels jointly predict adverse outcomes in patients
Shiyi Gao1, Yu Wang2, Jun Wang1
1Department of Cardiovascular Medicine, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China.
Insights
Coronary microvascular resistance (AMR) and HbA1c levels independently predict adverse cardiovascular events in type 2 diabetes patients after myocardial infarction. Combining these markers improves risk assessment for better patient outcomes.
Area of Science:
- Cardiology
- Diabetology
- Vascular Biology
Background:
- Limited research exists on coronary microcirculatory function in type 2 diabetes mellitus (T2DM) patients experiencing ST-segment elevation myocardial infarction (STEMI).
- Assessing microvascular resistance is crucial for understanding cardiovascular risk in diabetic patients post-STEMI.
Purpose of the Study:
- To investigate the association between angiography-derived microvascular resistance (AMR) and HbA1c levels with major adverse cardiovascular and cerebrovascular events (MACCEs) in STEMI patients with T2DM.
- To evaluate the combined predictive value of AMR and HbA1c for MACCEs in this patient cohort.
Main Methods:
- A cohort of 545 STEMI patients with T2DM undergoing culprit vessel revascularization were analyzed.
- Angiography-derived microvascular resistance (AMR) and HbA1c levels were assessed.
- Multivariable Cox proportional hazards models and restricted cubic spline analysis were used to determine associations with MACCEs.
Main Results:
- Elevated HbA1c (HR=1.403) and AMR (HR=1.213) were independently associated with increased MACCEs.
- Patients with both high HbA1c (≥6.5%) and high AMR (≥250.5 mmHg·s/m) had the highest MACCEs risk (HR=6.903).
- Nonlinear relationships were observed between MACCEs incidence and both HbA1c and AMR levels.
Conclusions:
- Elevated AMR post-PCI independently predicts MACCEs in STEMI patients with T2DM.
- Combined assessment of AMR and HbA1c enhances MACCEs risk stratification.
- Optimizing glycemic control and assessing coronary microcirculatory function may improve long-term outcomes.
Introduction:
Research on coronary microcirculatory function in type 2 diabetes mellitus (T2DM) patients with ST-segment elevation myocardial infarction (STEMI) remains limited.
Methods:
Patients diagnosed with new-onset STEMI between January 2022 and December 2023 were enrolled. All underwent culprit vessel revascularization, with simultaneous blood sampling and angiography-derived microvascular resistance (AMR) assessment in the reperfused vessel. The primary endpoint was the incidence of major adverse cardiovascular and cerebrovascular events (MACCEs).
Results:
A total of 545 patients were divided into four groups based on HbA1c and AMR levels. After adjustment for covariates using a multivariable Cox proportional hazards model, HbA1c (HR = 1.403, 95% CI: 1.131-1.740), AMR (HR = 1.213, 95% CI: 1.105-1.520), and NT-proBNP (HR = 1.244, 95% CI: 1.1053-2.868) remained independently associated with MACCEs. Patients with HbA1c ≥6.5% and AMR ≥250.5 mmHg·s/m exhibited the highest risk of MACCEs (HR = 6.903, 95% CI:3.260-14.618, P < 0.001). Restricted cubic spline analysis revealed nonlinear relationships between MACCEs and both HbA1c and AMR levels. RCS analysis indicated nonlinear relationships between MACCEs incidence and both HbA1c and AMR levels.
Conclusion:
This study demonstrates that an elevated AMR following PCI independently predicts MACCEs in patients with STEMI and T2DM. Combined evaluation of AMR and HbA1c enhances risk stratification for MACCEs. Assessment of coronary microcirculatory function and sustained optimization of glycemic control may contribute to improved long-term clinical outcomes in this population.
