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Prognostic Value of Coronary Angiography–Derived Index of Microcirculatory Resistance in Non–ST-Segment Elevation Myocardial Infarction Patients

心脏病学 医学 内科学 心肌梗塞 冠状动脉造影 血管造影 索引(排版) 仰角(弹道) 几何学 数学 计算机科学 万维网
作者
Yuxuan Zhang,Jun Pu,Tiesheng Niu,Jiacheng Fang,Delong Chen,Abuduwufuer Yidilisi,Yiyue Zheng,Jia Jie Lu,Yumeng Hu,Bon‐Kwon Koo,Jianping Xiang,Jianan Wang,Jun Jiang
出处
期刊:Jacc-cardiovascular Interventions [Elsevier BV]
卷期号:17 (16): 1874-1886 被引量:8
标识
DOI:10.1016/j.jcin.2024.04.048
摘要

The index of microcirculatory resistance is a reliable measure for evaluating coronary microvasculature, but its prognostic value in patients with non–ST-segment elevation myocardial infarction (NSTEMI) remains unclear. This study aimed to evaluate the prognostic impact of post–percutaneous coronary intervention (PCI) angiography-derived index of microcirculatory resistance (angio-IMR) in patients with NSTEMI. The culprit vessel's angio-IMR was measured after PCI in 2,212 NSTEMI patients at 3 sites. The primary endpoint was 2-year major adverse cardiac events (MACEs), defined as a composite of cardiac death, readmission for heart failure, myocardial reinfarction, and target vessel revascularization. The mean post-PCI angio-IMR was 20.63 ± 4.17 in NSTEMI patients. Two hundred six patients were categorized as the high post-PCI angio-IMR group according to maximally selected log-rank statistics. Patients with angio-IMR >25 showed a higher rate of MACEs than those with angio-IMR ≤25 (32.52% vs 9.37%; P < 0.001). Post-PCI angio-IMR >25 was an independent predictor of MACEs (HR: 4.230; 95% CI: 3.151-5.679; P < 0.001) and showed incremental prognostic value compared with conventional risk factors (AUC: 0.774 vs 0.716; P < 0.001; net reclassification index: 0.317; P < 0.001; integrated discrimination improvement: 0.075; P < 0.001). In patients undergoing PCI for NSTEMI, an increased post-PCI angio-IMR is associated with a higher risk of MACEs. The addition of post-PCI angio-IMR into conventional risk factors significantly improves the ability to reclassify patients and estimate the risk of MACEs. (Angiograph-Derived Index of Microcirculatory Resistance in Patients With Acute Myocardial Infarction; NCT05696379)
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