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March 7, 2026Circulation ReportsOpen Access

Relationship Between Post-Procedural Angiography-Derived Index of Microcirculatory Resistance and Periprocedural Myocardial Injury After Percutaneous Coronary Intervention

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Why the study?

Periprocedural myocardial injury is a common complication of PCI linked to elevated post-PCI IMR, but the association between pressure-wire-free angiography-derived IMR and PMI needed to be established.

Does post-PCI angiography-derived index of microcirculatory resistance (angio-IMR) predict periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention?

Comparison

Post-PCI angio-IMR levels in relation to PMI

Key result

Post-PCI angio-IMR ≥29 was associated with a 67.6% incidence of periprocedural myocardial injury compared to 12.5% with angio-IMR <29, with OR 14.96 (95% CI 4.98–44.91; P<0.001).

Authors

TMTetsuya MatsuyamaTOT OkamuraTFTatsuhiro Fujimura

Discussion

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Overview

May identify high-risk patients for periprocedural injury after elective PCI; extends angio-IMR evidence but remains hypothesis-generating pending validation.

Key Points

  • The aim is to investigate the relationship between angiography-derived index of microcirculatory resistance and periprocedural myocardial injury after PCI.
  • Assessment of post-PCI angiography-derived index of microcirculatory resistance (angio-IMR)
  • Analysis of periprocedural myocardial injury occurrences
  • Correlation analysis between angio-IMR values and PMI
  • Higher post-PCI angio-IMR values are associated with increased incidence of myocardial injury.
  • Findings suggest that angio-IMR can serve as a useful indicator for predicting myocardial injury after PCI.

Study Design

Type

Observational (n=101)

Multicenter

No

Structured PICO

Does post-PCI angiography-derived index of microcirculatory resistance (angio-IMR) predict periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention?

P
Population
101 consecutive patients who underwent elective percutaneous coronary intervention (PCI) for de novo coronary artery disease, mean age 72.8 years, 81.9% male, from a single center in Japan. Excluded: acute myocardial infarction, cardiopulmonary resuscitation, single-session multivessel PCI, target lesion revascularization, stentless PCI, and procedures with evident complications (side branch occlusion, flow-limiting dissection, perforation, distal embolization).
I
Intervention
Post-PCI angiography-derived index of microcirculatory resistance (angio-IMR) measurement using 3D quantitative flow ratio software.
O
Outcome
Occurrence of periprocedural myocardial injury (PMI) within 48 hours after PCI, defined according to the Fourth Universal Definition of Myocardial Infarction.surrogate

Main Result

Effect estimate: OR 14.96 (95% CI 4.98–44.91)

Absolute Event Rate: 67.6% vs 12.5%

p-value: p=<0.001

Elevated post-PCI angiography-derived index of microcirculatory resistance (angio-IMR) is strongly associated with periprocedural myocardial injury and may serve as a non-invasive predictive tool following elective PCI.

Limitations

  • Single-center, retrospective design with relatively small sample size
  • Possible selection bias due to cTn measurements performed mainly in symptomatic patients
  • Change in biomarker used to diagnose PMI from troponin T to troponin I during study period
  • Minimal occurrence of procedure-related myocardial infarction focusing primarily on PMI of lesser prognostic significance
  • Angio-IMR measured only post-PCI without assessment of pre-existing coronary microvascular dysfunction
  • Prognostic impact of post-PCI angio-IMR requires confirmation in large-scale clinical trials
  • Single-center, retrospective study with a relatively small sample size
  • Selection bias due to post-PCI cTn measurements likely being performed in symptomatic patients
  • Biomarker used to diagnose PMI changed from cTnT to cTnI during the observation period
  • Occurrence of procedure-related myocardial infarction was minimal
  • Angio-IMR was measured only post-PCI, potentially including patients with pre-existing coronary microvascular dysfunction
  • Prognostic impact requires confirmation in large-scale clinical trials

Cite This Study

Matsuyama et al. (2026) conducted an observational in Patients undergoing elective percutaneous coronary intervention (PCI) for de novo coronary artery disease (n=101). Post-PCI angiography-derived index of microcirculatory resistance (angio-IMR) vs. Patients with post-PCI angio-IMR <29 was evaluated on Occurrence of periprocedural myocardial injury (PMI) within 48 hours after PCI defined by Fourth Universal Definition of Myocardial Infarction using post-PCI cardiac troponin elevation (OR 14.96, 95% CI 4.98–44.91, p=<0.001). Post-PCI angio-IMR ≥29 was associated with a 67.6% incidence of periprocedural myocardial injury compared to 12.5% with angio-IMR <29, with OR 14.96 (95% CI 4.98–44.91; P<0.001).

synapsesocial.com/papers/69abc1015af8044f7a4e9a2ahttps://doi.org/10.1253/circrep.cr-26-0006
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