Department of Cardiology of The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China; Cardiovascular Key Laboratory Zhejiang Province, Hangzhou, China.
Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
JACC Cardiovasc Interv. 2024 Aug 26;17(16):1874-1886. doi: 10.1016/j.jcin.2024.04.048. Epub 2024 Aug 7.
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 postpercutaneous 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. A total of 206 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).
微血管阻力指数是评估冠状动脉微血管的可靠指标，但在非 ST 段抬高型心肌梗死（NSTEMI）患者中的预后价值尚不清楚。
本研究旨在评估 NSTEMI 患者经皮冠状动脉介入治疗（PCI）后血管造影衍生的微血管阻力指数（angio-IMR）的预后影响。
在 3 个中心，对 2212 例 NSTEMI 患者进行 PCI 后，测量罪犯血管的 angio-IMR。主要终点为 2 年主要不良心脏事件（MACE），定义为心脏死亡、心力衰竭再入院、心肌梗死再发和靶血管血运重建的复合终点。
NSTEMI 患者 PCI 后的平均 post-PCI angio-IMR 为 20.63 ± 4.17。根据最大选择对数秩检验，共有 206 例患者被归类为高 post-PCI angio-IMR 组。angio-IMR>25 的患者 MACE 发生率高于 angio-IMR≤25 的患者（32.52% vs 9.37%；P<0.001）。post-PCI angio-IMR>25 是 MACE 的独立预测因子（HR：4.230；95%CI：3.151-5.679；P<0.001），与传统危险因素相比具有增量预后价值（AUC：0.774 vs 0.716；P<0.001；净重新分类指数：0.317；P<0.001；综合判别改善：0.075；P<0.001）。
在接受 PCI 治疗的 NSTEMI 患者中，post-PCI angio-IMR 增加与 MACE 风险增加相关。将 post-PCI angio-IMR 添加到传统危险因素中可显著提高重新分类患者和估计 MACE 风险的能力。（急性心肌梗死患者的血管造影衍生的微血管阻力指数；NCT05696379）。
