Zhong Sifang, Lu Jinyang, Gong Kaiyue, Wu Yixuan, Dong Zishuang, Lu Yuan
Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China.
Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Front Cardiovasc Med. 2025 May 1;12:1541208. doi: 10.3389/fcvm.2025.1541208. eCollection 2025.
More than half of ST-segment elevation myocardial infarction (STEMI) patients have coronary microcirculatory dysfunction (CMD) after percutaneous coronary intervention (PCI). This study aimed to explore the role of CMD in the occurrence of contrast-induced acute kidney injury (CI-AKI) in patients with STEMI.
This was a single-centre retrospective clinical observational study. Coronary angiography-derived index of microcirculatory resistance (caIMR) was measured and used to assess CMD. Regression analysis was used to identify risk factors for CI-AKI. Restricted cubic splines (RCS) was employed to examine the dose-response relationship between caIMR and CI-AKI. The predictive accuracy of the models was assessed with net reclassification index (NRI), and integrated discrimination improvement (IDI).
This study included 745 patients, the incidence of CI-AKI was 10.6% (79/745). Multivariate logistic regression identified caIMR (OR = 1.072, 95% CI: 1.051-1.094) as an independent predictor of CI-AKI. RCS analysis indicated a linear dose-response relationship between caIMR and CI-AKI. Receiver operating characteristic (ROC) analysis demonstrated that the areas under the curve for caIMR was 0.725, the optimal cutoff value was 25.95 U. Integration of caIMR could significantly improve the risk model for CI-AKI in STEMI patients (NRI = 0.721, IDI = 0.102, < 0.001).
Elevated caIMR is an independent risk factor for the development of CI-AKI after PCI in STEMI patients. Integrating caIMR significantly improves the risk model for CI-AKI.
超过一半的ST段抬高型心肌梗死（STEMI）患者在经皮冠状动脉介入治疗（PCI）后存在冠状动脉微循环功能障碍（CMD）。本研究旨在探讨CMD在STEMI患者对比剂诱导的急性肾损伤（CI-AKI）发生中的作用。
这是一项单中心回顾性临床观察研究。测量冠状动脉造影衍生的微循环阻力指数（caIMR）并用于评估CMD。采用回归分析确定CI-AKI的危险因素。使用限制立方样条（RCS）来检验caIMR与CI-AKI之间的剂量反应关系。用净重新分类指数（NRI）和综合判别改善（IDI）评估模型的预测准确性。
本研究纳入745例患者，CI-AKI的发生率为10.6%（79/745）。多因素逻辑回归确定caIMR（OR = 1.072，95%CI：1.051 - 1.094）是CI-AKI的独立预测因素。RCS分析表明caIMR与CI-AKI之间存在线性剂量反应关系。受试者工作特征（ROC）分析显示，caIMR的曲线下面积为0.725，最佳截断值为25.95 U。纳入caIMR可显著改善STEMI患者CI-AKI的风险模型（NRI = 0.721，IDI = 0.102，P < 0.001）。
caIMR升高是STEMI患者PCI后发生CI-AKI的独立危险因素。纳入caIMR可显著改善CI-AKI的风险模型。
