The Canadian journal of cardiology · 2026
Dynamic Changes and Prognostic Value of Angio-derived Index of Microcirculatory Resistance in Acute Myocardial Infarction: A Cohort Study.
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Wang Jingpu, Gao Wei, Wang Zhe, Zhang Fang, Song Jianhui, Zhang Qiyu, Zhou Jinying, Xu Rende, Ma Leilei, Xia Yan, Ma Jiaqi, Zhang Feng, Qian Juying, Chen Zhangwei, Li Chenguang, Ge Junbo
Аннотация
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.
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.