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

Q: What are the key findings of this study?

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).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Patients undergoing elective percutaneous coronary intervention (PCI) for de novo coronary artery disease (n=101). Intervention: Post-PCI angiography-derived index of microcirculatory resistance (angio-IMR) vs. Patients with post-PCI angio-IMR <29. Primary outcome: 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).

Q: What question did this study set out to answer?

To establish the association between post-percutaneous coronary intervention angiography-derived index of microcirculatory resistance and periprocedural myocardial injury.

Tetsuya Matsuyama; T Okamura; Tatsuhiro Fujimura; Yosuke Miyazaki; Takeshi Suetomi; Hideaki Akase; Yuki Nakata; Keita Kaneyuki; Motoaki Sano

doi:10.1253/circrep.cr-26-0006

March 4, 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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Key result

Post-PCI angio-IMR ≥29 linked to ~15-fold higher odds of periprocedural myocardial injury.

OR 14.96
95% CI 4.98–44.91
P<0.001
n=101

Figures

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?

Key Points

To establish the association between post-percutaneous coronary intervention angiography-derived index of microcirculatory resistance and periprocedural myocardial injury.
Retrospectively analyzed 101 percutaneous coronary intervention procedures.
Reconstructed three-dimensional vessel models from angiographic images to compute quantitative flow ratio and angiography-derived index of microcirculatory resistance without pressure wires.
Measured high-sensitivity troponin T or I within 48 h pre-procedure and 24 h post-procedure to identify periprocedural myocardial injury.
Patients with periprocedural myocardial injury had significantly higher post-PCI angio-IMR values than those without (31.8±5.9 vs. 23.8±6.0; P<0.001).
Receiver operating characteristic curve analysis revealed an AUC of 0.85 with an optimal cut-off value of 28.6; an angio-IMR threshold ≥29 yielded 75.8% sensitivity and 82.4% specificity.
The incidence of periprocedural myocardial injury was significantly higher in procedures with angio-IMR ≥29 compared with low angio-IMR values (67.6% vs. 12.5%; P<0.001).

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

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Implication

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

Abstract

Background: Periprocedural myocardial injury (PMI) is a common complication of percutaneous coronary intervention (PCI). Elevated post-PCI index of microcirculatory resistance (IMR) has been linked to PMI. The angiography-derived IMR (angio-IMR) serves as a pressure-wire-free method to assess coronary microvascular function. This study aimed to establish the association between post-PCI angio-IMR and PMI.

Discussion

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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/69abc1015af8044f7a4e9a2a https://doi.org/10.1253/circrep.cr-26-0006

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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