Eerdekens Rob, El Farissi Mohamed, De Maria Giovanni Luigi, van Royen Niels, van 't Veer Marcel, van Leeuwen Maarten A H, Hoole Stephen P, Marin Federico, Carrick David, Tonino Pim A L, Pijls Nico H J, Fineschi Massimo, Oldroyd Keith G, Berry Colin, Banning Adrian P, Fearon William F, Zimmermann Frederik M
Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands.
Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, United Kingdom.
J Am Coll Cardiol. 2024 May 3. doi: 10.1016/j.jacc.2024.02.052.
The microvascular resistance reserve (MRR) has recently been introduced as a novel index to assess the vasodilatory capacity of the microcirculation, independent of epicardial disease. The prognostic value of MRR in ST-segment elevation myocardial infarction (STEMI) is unknown.
The aim of this analysis was to investigate the prognostic value of MRR in patients with STEMI and to compare MRR with cardiovascular magnetic resonance imaging parameters.
From a pooled analysis of individual patient data from 6 cohorts that measured the index of microcirculatory resistance (IMR) directly after primary percutaneous coronary intervention in patients with STEMI (n = 1,265), a subgroup analysis was performed in patients in whom both MRR and IMR were available. The primary endpoint was the composite of all-cause mortality or hospitalization for heart failure.
Both MRR and IMR could be calculated in 446 patients. The optimal cutoff of MRR to predict the primary endpoint in this STEMI population was 1.25. During a median follow-up of 3.1 years (Q1-Q3: 1.5-6.1 years), the composite of all-cause mortality or hospitalization for heart failure occurred in 27.3% and 5.9% of patients (HR: 4.16; 95% CI: 2.31-7.50; P < 0.001) in the low MRR (≤1.25) and high MRR (>1.25) groups, respectively. Both IMR and MRR were independent predictors of the composite of all-cause mortality or hospitalization for heart failure.
MRR measured directly after primary percutaneous coronary intervention was an independent predictor of the composite of all-cause mortality or hospitalization for heart failure during long-term follow-up.
微血管阻力储备（MRR）最近被引入作为一种新的指标，用于评估微循环的血管舒张能力，独立于心外膜疾病。MRR在ST段抬高型心肌梗死（STEMI）中的预后价值尚不清楚。
本分析的目的是研究MRR在STEMI患者中的预后价值，并将MRR与心血管磁共振成像参数进行比较。
对6个队列的个体患者数据进行汇总分析，这些队列在STEMI患者（n = 1265）接受直接经皮冠状动脉介入治疗后直接测量微循环阻力指数（IMR），对同时有MRR和IMR数据的患者进行亚组分析。主要终点是全因死亡率或因心力衰竭住院的复合终点。
446例患者可计算出MRR和IMR。在该STEMI人群中，预测主要终点的MRR最佳截断值为1.25。在中位随访3.1年（第一四分位数-第三四分位数：1.5-6.1年）期间，低MRR（≤1.25）组和高MRR（>1.25）组分别有27.3%和5.9%的患者发生全因死亡率或因心力衰竭住院的复合终点（HR：4.16；95%CI：2.31-7.50；P < 0.001）。IMR和MRR都是全因死亡率或因心力衰竭住院复合终点的独立预测因素。
直接经皮冠状动脉介入治疗后测量的MRR是长期随访期间全因死亡率或因心力衰竭住院复合终点的独立预测因素。
