The coronary angiography-derived index of microcirculatory resistance predicts perioperative myocardial injury in stable coronary artery disease patients undergoing PCI.

BACKGROUND

Coronary microvascular dysfunction (CMD) assessed by the index of microcirculatory resistance (IMR) is associated with perioperative myocardial injury (PMI).The angiographically derived index of microcirculatory resistance (caIMR) represents a novel and accurate alternative to IMR.

OBJECTIVE

This study aims to evaluate the predictive ability of caIMR for PMI in patients with stable coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI).

METHODS

Consecutive patients with stable CAD undergoing elective PCI of a single lesion were recruited. caIMR was measured before and after revascularisation, and total creatine kinase-MB (CK-MB) and high-sensitivity troponin T (hsTnT) levels were measured before and within 24 h after PCI.

RESULTS

A total of 65 patients were enrolled and 26 patients fulfilled the diagnostic criteria for PMI. Post-PCI caIMR values were significantly higher in the PMI group than in the control group (27.02 ± 3.70 vs. 15.91 ± 3.43U,  < 0.001). Pearson correlation analysis showed that increased post-PCI caIMR values had a significant positive correlation with peak hsTnT (r = 0.803,  < 0.001) and peak CK-MB (r = 0.512, P = 0.001). Multivariate logistic regression analysis showed that post-PCI caIMR was an independent predictor of PMI (OR,1.731; 95 % CI:1.348-2.023;  < 0.001).ROC analysis suggested that the best cut-off value of post-PCI caIMR was 25.17U to diagnose PMI (AUC = 0.951, sensitivity 88.5 %, specificity 97.1 %). During a median follow-up 16 months, patients with PMI had a higher incidence of major adverse cardiovascular events (MACE) (42.31 % vs 5.13 %,  = 0.04).

CONCLUSIONS

Post-PCI caIMR can accurately predict PMI and clinical outcomes in stable CAD patients undergoing elective PCI, which supports the use of caIMR in clinical practice.