Key result
Patients with STEMI and T2DM exhibiting both elevated HbA1c (≥6.5%) and elevated angiography-derived microvascular resistance (≥250.5 mmHg·s/m) had a nearly 7-fold increased risk of MACCEs (HR 6.903) compared to those with lower levels.
Why the study?
Research on coronary microcirculatory function in patients with type 2 diabetes mellitus and STEMI remains limited.
Do elevated angiography-derived microvascular resistance and HbA1c levels predict major adverse cardiovascular and cerebrovascular events in patients with diabetic STEMI?
Cohort (n=545)
Yes
Do elevated angiography-derived microvascular resistance and HbA1c levels predict major adverse cardiovascular and cerebrovascular events in patients with diabetic STEMI?
Hazard Ratio: 6.903 (95% CI 3.26–14.618)
Absolute Event Rate: 24.32% vs 4.03%
p-value: p=<0.001
Elevated angiography-derived microvascular resistance and HbA1c levels jointly predict a significantly higher risk of MACCEs in patients with STEMI and T2DM, suggesting their combined use enhances risk stratification.
Introduction: Research on coronary microcirculatory function in type 2 diabetes mellitus (T2DM) patients with ST-segment elevation myocardial infarction (STEMI) remains limited. Methods: Patients diagnosed with new-onset STEMI between January 2022 and December 2023 were enrolled. All underwent culprit vessel revascularization, with simultaneous blood sampling and angiography-derived microvascular resistance (AMR) assessment in the reperfused vessel. The primary endpoint was the incidence of major adverse cardiovascular and cerebrovascular events (MACCEs). Results: A total of 545 patients were divided into four groups based on HbA1c and AMR levels. After adjustment for covariates using a multivariable Cox proportional hazards model, HbA1c (HR = 1.403, 95% CI: 1.131-1.740), AMR (HR = 1.213, 95% CI: 1.105-1.520), and NT-proBNP (HR = 1.244, 95% CI: 1.1053-2.868) remained independently associated with MACCEs. Patients with HbA1c ≥6.5% and AMR ≥250.5 mmHg·s/m exhibited the highest risk of MACCEs (HR = 6.903, 95% CI:3.260-14.618, P < 0.001). Restricted cubic spline analysis revealed nonlinear relationships between MACCEs and both HbA1c and AMR levels. RCS analysis indicated nonlinear relationships between MACCEs incidence and both HbA1c and AMR levels. Conclusion: This study demonstrates that an elevated AMR following PCI independently predicts MACCEs in patients with STEMI and T2DM. Combined evaluation of AMR and HbA1c enhances risk stratification for MACCEs. Assessment of coronary microcirculatory function and sustained optimization of glycemic control may contribute to improved long-term clinical outcomes in this population.
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Shiyi et al. (2026) conducted a cohort in ST-segment elevation myocardial infarction and type 2 diabetes mellitus (n=545). Elevated HbA1c (≥6.5%) and elevated angiography-derived microvascular resistance (AMR ≥250.5 mmHg·s/m) vs. HbA1c <6.5% and AMR <250.5 mmHg·s/m was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCEs) (HR 6.903, 95% CI 3.260-14.618, p=<0.001). Patients with STEMI and T2DM exhibiting both elevated HbA1c (≥6.5%) and elevated angiography-derived microvascular resistance (≥250.5 mmHg·s/m) had a nearly 7-fold increased risk of MACCEs (HR 6.903) compared to those with lower levels.
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