What question did this study set out to answer?

This research aims to explore how insulin resistance impacts coronary microcirculatory function and major adverse cardiovascular events in non-diabetic STEMI patients.

January 10, 2026Frontiers in Cardiovascular Medicine0 citationsOpen Access

Association between insulin resistance and coronary microcirculatory function and adverse cardiovascular events after PCI in non-diabetic STEMI patients

JZJinrong Zhong LTLiming Tang YZYuanfeng Zhang

Key Result

In non-diabetic STEMI patients, high HOMA-IR is an independent risk factor for 1-year major adverse cardiovascular events and associated with microcirculatory dysfunction.

Key Points

This research aims to explore how insulin resistance impacts coronary microcirculatory function and major adverse cardiovascular events in non-diabetic STEMI patients.
Retrospective analysis of 298 non-diabetic STEMI patients undergoing emergency PCI.
Participants categorized into HOMA-IR tertiles to evaluate microcirculation function.
IMR and CFR determined to assess coronary microcirculatory function.
Correlations between HOMA-IR and IMR/CFR analyzed using Pearson correlation.
Logistic regression and Cox regression used to identify predictors and assess risk factors for MACE.
Higher HOMA-IR levels correlated with increased IMR and decreased CFR.
Patients with elevated HOMA-IR experienced significantly more MACE after one year.
Multivariate analysis confirmed high HOMA-IR as an independent predictor of microcirculatory dysfunction.
High HOMA-IR was identified as a risk factor for one-year MACE.

Structured PICO

Does elevated insulin resistance (HOMA-IR) predict coronary microcirculatory dysfunction and 1-year MACE in non-diabetic STEMI patients undergoing PCI?

Population

n=298 non-diabetic STEMI patients who underwent emergency PCI. Exclusions: prior diagnosis of diabetes or HbA1c ≥ 6.5%, chronic inflammatory disease, malignancy, renal insufficiency (eGFR < 30 mL/min·1.73 m2), cardiogenic shock, prior MI, PCI, or CABG.

Intervention

High Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) tertile

Comparator

Low and medium HOMA-IR tertiles

Outcome

Immediate post-PCI index of microcirculatory resistance (IMR) and coronary flow reserve (CFR), and 1-year incidence of Major Adverse Cardiovascular Events (MACE: composite of all-cause death, recurrent MI, hospitalization for heart failure, or target vessel revascularization)composite

In non-diabetic STEMI patients undergoing PCI, elevated insulin resistance (HOMA-IR) is an independent predictor of coronary microvascular dysfunction and 1-year adverse cardiovascular events.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Objective Hyperglycemia and insulin resistance (IR) are common in patients with acute ST-segment elevation myocardial infarction (STEMI). However, the impact of IR on coronary microcirculatory function in non-diabetic STEMI patients remains unclear. This study aimed to investigate the relationship between IR and coronary microcirculation function and the incidence of major adverse cardiovascular events (MACE) at one year after Percutaneous Coronary Intervention (PCI) in non-diabetic STEMI patients. Methods A total of 298 non-diabetic STEMI patients who underwent emergency PCI between 2022 and 2024 were retrospectively enrolled. Patients were divided into low, medium, and high groups based on Homeostasis Model Assessment of Insulin Resistance (HOMA-IR tertiles). Coronary microcirculation function was assessed using the index of microcirculatory resistance (IMR) and coronary flow reserve (CFR). IMR, CFR, and MACE were compared among the three groups. Pearson correlation was used to analyze the relationships between HOMA-IR and IMR/CFR. Logistic regression was used to identify predictors of microcirculatory dysfunction, and Cox regression was used to assess risk factors for MACE. Results IMR increased and CFR decreased with rising HOMA-IR levels ( P 0.001). HOMA-IR was positively correlated with IMR and negatively correlated with CFR. Patients with higher HOMA-IR levels had significantly higher 1-year MACE incidence than those with lower HOMA-IR. Multivariate logistic regression analysis showed that high HOMA-IR was an independent predictor of elevated IMR (≥25) and reduced CFR (2.0). Multivariate Cox regression analysis indicated that high HOMA-IR was an independent risk factor for MACE. Conclusion In non-diabetic STEMI patients, elevated HOMA-IR is closely associated with coronary microcirculatory dysfunction and increased risk of 1-year MACE. Routine assessment of HOMA-IR may help identify high-risk individuals and support the development of individualized treatment strategies.

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