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Angiography-Derived Index of Microcirculatory Resistance Predicts Microvascular Obstruction and Infarct Size in
Xincheng Sheng1, Yumeng Hu2, Yizhi Zhang3
1Department of Cardiology, Punan Branch of Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Cardiology, Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
AccuIMR, an angiography-based method, effectively assesses microvascular dysfunction (MVD) in ST-segment elevation myocardial infarction (STEMI) patients post-PCI. It improves prediction of cardiac damage and function when combined with traditional factors.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Microvascular dysfunction (MVD) assessment is crucial in ST-segment elevation myocardial infarction (STEMI).
- AccuIMR, a novel angiography-derived index, simulates the index of microcirculatory resistance (IMR) and correlates well with wire-based IMR.
- Evaluating MVD non-invasively is a key challenge in STEMI management.
Purpose of the Study:
- To evaluate the clinical significance of angiography-derived index of microcirculatory resistance (AccuIMR) in STEMI patients.
- To determine if AccuIMR can predict microvascular obstruction and infarct size.
- To assess the added value of AccuIMR to conventional predictive factors.
Main Methods:
- Retrospective analysis of a prospective multicenter STEMI registry (n=482).
- AccuIMR calculated from angiographic images post-percutaneous coronary intervention (PCI).
- Patients stratified into MVD (AccuIMR >40) and non-MVD (AccuIMR ≤40) groups; cardiac magnetic resonance (CMR) used for reference standard.
Main Results:
- The MVD group showed larger CMR-derived microvascular obstruction (CMR-MVO) and infarct size, with lower left ventricular ejection fraction.
- AccuIMR >40 was an independent predictor of CMR-MVO (OR: 4.730) and larger infarct size (OR: 2.101).
- Incorporating AccuIMR significantly improved predictive accuracy for CMR-MVO and infarct size.
Conclusions:
- AccuIMR is an efficient and reliable method for evaluating MVD in STEMI patients after PCI.
- AccuIMR provides supplementary information on cardiac function when combined with conventional predictive factors.
- This angiography-based assessment aids in risk stratification and management of STEMI.
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