Wu Yixuan, Liu Jiahua, Du Xinjia, Li Maochen, Ren Yanfei, Chen Lei, Lu Yuan
Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China; Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Can J Cardiol. 2025 May 9. doi: 10.1016/j.cjca.2025.05.001.
The occurrence of coronary microvascular dysfunction (CMD) after primary PCI in patients with diabetes mellitus (DM) and ST-elevation myocardial infarction (STEMI), and its impact on prognosis remains elusive.
This single-centre retrospective observational study included 293 patients diagnosed with DM and STEMI. The coronary-angiography-derived index of microvascular resistance (caIMR) was calculated using the measurement software FlashAngio (Suzhou Rainmed Medical Technology Company, Ltd, Suzhou, Jiangsu, China), whereas cardiac magnetic resonance parameters were quantified using the postprocessing software Cvi42. CMD was defined as caIMR ≥ 25 U. The primary endpoint was major adverse cardiac events (MACE), defined as all-cause mortality, nonfatal myocardial infarction, ischemia-driven revascularization, and heart failure.
MACE occurred in 86 patients (29.4%) during a median follow-up of 31 months. A significant correlation was identified between caIMR and both microvascular obstruction (MVO) (R = 0.61, P < 0.001) and infarct size (IS) (R = 0.39, P < 0.001). Furthermore, caIMR ≥ 25 was identified as an independent risk factor for MACE (hazard ratio [HR], 2.99; 95% confidence interval [CI], 1.78-5.03; P < 0.001). In addition, the integration of caIMR into risk modelling significantly improved prediction of MACE (net reclassification improvement 0.264, P < 0.001; integrated discrimination improvement 0.060, P < 0.001). Finally, the Kaplan-Meier survival curves displayed that patients with caIMR ≥ 25 were at a higher risk of MACE (log-rank P < 0.001).
The caIMR demonstrated a satisfactory correlation with CMR-determined MVO and IS in patients with DM and STEMI. Elevated caIMR was independently linked to a higher risk of MACE in patients with diabetes and STEMI post-PCI, serving as an effective predictor for MACE.
XYFY2023-KL203-01.
糖尿病（DM）合并ST段抬高型心肌梗死（STEMI）患者在接受直接经皮冠状动脉介入治疗（PCI）后发生冠状动脉微血管功能障碍（CMD）的情况及其对预后的影响仍不明确。
这项单中心回顾性观察性研究纳入了293例诊断为DM和STEMI的患者。使用FlashAngio测量软件（苏州润迈德医疗科技有限公司，中国江苏苏州）计算基于冠状动脉造影的微血管阻力指数（caIMR），而使用后处理软件Cvi42对心脏磁共振参数进行定量分析。CMD定义为caIMR≥25 U。主要终点是主要不良心脏事件（MACE），定义为全因死亡、非致命性心肌梗死、缺血驱动的血运重建和心力衰竭。
在31个月的中位随访期内，86例患者（29.4%）发生了MACE。caIMR与微血管阻塞（MVO）（R = 0.61，P < 0.001）和梗死面积（IS）（R = 0.39，P < 0.001）均显著相关。此外，caIMR≥25被确定为MACE的独立危险因素（风险比[HR]，2.99；95%置信区间[CI]，1.78 - 5.03；P < 0.001）。此外，将caIMR纳入风险模型显著改善了MACE的预测（净重新分类改善0.264，P < 0.001；综合判别改善0.060，P < 0.001）。最后，Kaplan-Meier生存曲线显示，caIMR≥25的患者发生MACE的风险更高（对数秩P < 0.001）。
在DM和STEMI患者中，caIMR与心脏磁共振测定的MVO和IS显示出良好的相关性。PCI术后糖尿病和STEMI患者中，caIMR升高与MACE风险较高独立相关，可作为MACE的有效预测指标。
XYFY2023-KL203-01。
