Key result
AngioIMR > 40 is linked to ~328% greater MACE risk in STEMI patients.
Why the study?
The prognostic value of AngioIMR, a novel wire- and hyperemia-free method for measuring angiography-derived index of microvascular resistance, was unknown in STEMI patients.
Does significant coronary microvascular dysfunction (AngioIMR > 40) predict all-cause death or heart failure hospitalization in STEMI patients undergoing primary PCI?
Cohort (n=178)
Does significant coronary microvascular dysfunction (AngioIMR > 40) predict all-cause death or heart failure hospitalization in STEMI patients undergoing primary PCI?
Effect estimate: HR 4.282 (95% CI 2.325-7.886)
Absolute Event Rate: 70% vs 27%
p-value: p=< 0.0001
Elevated AngioIMR (>40) measured immediately after primary PCI is a strong independent predictor of all-cause death or heart failure hospitalization in STEMI patients.
Elevated post-PCI AngioIMR may identify high-risk STEMI patients; leaves open whether it guides management or requires prospective validation.
Background: Several methods for measuring IMR derived from angiography have been developed. AngioIMR is a novel method for the assessment of angiography-derived IMR with no requirement for a wire and hyperemia. The prognostic value of AngioIMR is unknown in STEMI patients. We aimed to provide the prognostic value of AngioIMR in patients with ST-elevation myocardial infarction (STEMI). Methods: This study included patients with STEMI who underwent invasive coronary angiography and primary percutaneous coronary intervention (PPCI). AngioIMR was calculated using computational flow and pressure simulation immediately after PPCI. The presence of significant coronary microvascular dysfunction was defined as AngioIMR > 40. The primary outcome was a composite of all cause death or hospitalization for heart failure (MACE). Results: A total of 178 patients were included (65.0 ± 12.8 years on average, 74 % male gender). An AngioIMR > 40 was found in 72 patients. During a median follow-up of 2.9 (2.3-6.9) years, a primary endpoint was observed in 56 patients. By Kaplan-Meier analysis, the risk of MACE was significantly higher in patients with AngioIMR > 40 (log-rank P < 0.01). An Angio IMR > 40 was significantly associated with the occurrence of the primary endpoint in univariate (70 % vs 27 %; hazard ratio 4.519; 95 % CI: 2.550-8.009; p < 0.0001) and multivariate analysis (Hazard ratio 4.282; 95 % CI: 2.325-7.886; p < 0.0001). AngioIMR model showed incremental prognostic value compared to a model with clinical and imaging risk predictors (C-index 0.84 vs 0.79; p = 0.04). Conlusion: Elevated AngioIMR showed a independent prognostic significance in STEMI patients. In addition to well-known risk factors, assessment of coronary microvascular dysfunction can be a feasible approach for early prevention and a therapeutic target in STEMI patients.
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Caullery et al. (2024) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=178). AngioIMR > 40 vs. AngioIMR ≤ 40 was evaluated on Composite of all cause death or hospitalization for heart failure (MACE) (HR 4.282, 95% CI 2.325-7.886, p=< 0.0001). An AngioIMR > 40 was significantly associated with a higher risk of all-cause death or heart failure hospitalization in STEMI patients (HR 4.282; 95% CI 2.325-7.886; p<0.0001).
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