The independent value and clinical significance of angio-based microvascular resistance in predicting adverse cardiovascular events in patients with acute ST-elevation myocardial infarction

Background Angio-based microvascular resistance (AMR) may influence the incidence of major adverse cardiovascular events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). However, its value as an independent predictive marker remains unclear. Methods This study included 483 patients diagnosed with STEMI who underwent PCI between January 2021 and July 2023. The patients were classified into high and low AMR groups based on the AMR threshold. The relationship between AMR and MACE was assessed using multivariate logistic regression analysis, and the cumulative incidence of MACE was analyzed using Kaplan–Meier survival curves. Additionally, receiver operating characteristic (ROC) curves were used to determine the optimal cutoff value for AMR and its predictive efficacy. Results During the 12-month follow-up period, the cumulative incidence of MACE was significantly higher in the high AMR group than in the low AMR group ( P 0.0001). Multivariate logistic regression analysis indicated that AMR was an independent predictor of MACE (HR = 1.085, 95% CI: 1.037–1.248, P 0.001). Kaplan–Meier survival curve analysis further validated a poorer prognosis in the high AMR group, with a significantly increased risk of MACE. ROC curve analysis established the optimal cutoff value of AMR at 246.5 mmHg·s/m, at which the sensitivity for predicting MACE was 0.98, with a specificity of 0.67 and an area under the curve of 0.889, indicating good predictive performance. Additionally, diabetes, hyperlipidemia, and elevated levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) were significantly associated with the occurrence of MACE. Conclusion AMR holds independent prognostic value for predicting MACE, with an optimal cutoff of 246.5 mmHg·s/m, facilitating early risk stratification by identifying high-risk patients. Additionally, diabetes, hyperlipidemia, and elevated NT-proBNP levels were significantly associated with an increased risk of MACE. A low postoperative quantitative flow ratio also correlated with a higher MACE risk, further highlighting the impact of coronary blood flow restoration on patient outcomes.