Candreva Alessandro, Gotschy Alexander, Stehli Julia, Bissig Lea, Lodi Rizzini Maurizio, Chiastra Claudio, Gallo Diego, Morbiducci Umberto, Klingenberg Roland, Heg Dik, Matter Christian M, Ruschitzka Frank, Manka Robert, Stähli Barbara E
Department of Cardiology, University Heart Center, University Hospital Zurich University of Zurich Zurich Switzerland.
PolitoBIO Med Lab, Department of Mechanical and Aerospace Engineering Politecnico di Torino Turin Italy.
J Am Heart Assoc. 2025 Feb 18;14(4):e036033. doi: 10.1161/JAHA.124.036033. Epub 2025 Feb 8.
Coronary microvascular dysfunction has been associated with adverse cardiovascular events following acute myocardial infarction. This study evaluates the role of the angiography-derived index of microcirculatory resistance (angio-IMR) in predicting myocardial damage in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI).
In this post hoc analysis of the CLEVER-ACS (Controlled-Level Everolimus in Acute Coronary Syndromes) trial, the associations between post-PCI angio-IMR of infarct-related coronary arteries (IRAs) and infarct size, microvascular obstruction, and left ventricular ejection fraction at 30 days as assessed by cardiac magnetic resonance were investigated. High post-PCI angio-IMR was defined as ≥40 mm Hgs . In non-IRAs, angio-IMR was measured before IRA-PCI. A total of 52 IRAs and 94 non-IRAs of 52 patients were analyzed. Post-PCI angio-IMR was 41.5 (interquartile range [IQR], 28.5-55.7) mm Hgs in IRAs and pre-PCI angio-IMR was 43.7 (IQR, 31.7-54.0) mm Hg*s in non-IRAs (=0.70). Patients with high post-PCI angio-IMR (52%) exhibited a larger myocardial infarct size (36.0 [IQR, 23.0-52.5] g versus 14.5 [IQR, 6.50-26.5] g, <0.001) and a lower left ventricular ejection fraction (46.5% [IQR, 39.5%-49.5%] versus 55.0% [IQR, 48.0%-61.4%], =0.002) at 30 days as compared with those with low post-PCI angio-IMR values. Post-PCI angio-IMR positively correlated with myocardial infarct size (r=0.45, =0.001) and extent of microvascular obstruction (r=0.40, =0.004) at 30 days. Post-PCI angio-IMR predicted myocardial infarct size (area under the curve, 0.78 [IQR, 0.65-0.92]; =0.001) and extent of microvascular obstruction (area under the curve, 0.74 [IQR, 0.60-0.89]; =0.009) at 30 days.
In patients with ST-segment-elevation myocardial infarction, post-PCI angio-IMR was identified as independent predictor of myocardial infarct size and extent of microvascular obstruction.
URL: https://clinicaltrials.gov; Unique Identifier: NCT01529554.
冠状动脉微血管功能障碍与急性心肌梗死后不良心血管事件相关。本研究评估了血管造影衍生的微循环阻力指数（血管造影-IMR）在预测接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死患者心肌损伤中的作用。
在这项对CLEVER-ACS（急性冠状动脉综合征中依维莫司的对照水平）试验的事后分析中，研究了梗死相关冠状动脉（IRA）PCI术后血管造影-IMR与梗死面积、微血管阻塞以及30天时通过心脏磁共振评估的左心室射血分数之间的关联。PCI术后高血管造影-IMR定义为≥40 mmHgs。在非IRA中，血管造影-IMR在IRA-PCI之前测量。共分析了52例患者的52条IRA和94条非IRA。IRA中PCI术后血管造影-IMR为41.5（四分位间距[IQR]，28.5 - 55.7）mmHgs，非IRA中PCI术前血管造影-IMR为43.7（IQR，31.7 - 54.0）mmHg*s（P = 0.70）。PCI术后血管造影-IMR高的患者（52%）在30天时显示出更大的心肌梗死面积（36.0 [IQR，23.0 - 52.5] g对14.5 [IQR，6.50 - 26.5] g，P < 0.001）和更低的左心室射血分数（46.5% [IQR，39.5% - 49.5%]对55.0% [IQR，48.0% - 61.4%]，P = 0.002），与PCI术后血管造影-IMR值低的患者相比。PCI术后血管造影-IMR与30天时心肌梗死面积（r = 0.45，P = 0.001）和微血管阻塞程度（r = 0.40，P = 0.004）呈正相关。PCI术后血管造影-IMR可预测30天时的心肌梗死面积（曲线下面积，0.78 [IQR，0.65 - 0.92]；P = 0.001）和微血管阻塞程度（曲线下面积，0.74 [IQR，0.60 - 0.89]；P = 0.009）。
在ST段抬高型心肌梗死患者中，PCI术后血管造影-IMR被确定为心肌梗死面积和微血管阻塞程度的独立预测指标。
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