A non-hyperaemic angiography-derived index of microcirculatory resistance (NH IMRangio) > 43U independently predicted a composite of all-cause mortality, resuscitated cardiac arrest, and new heart failure (adjusted HR 2.13).
Cohort (n=262)
No
Does a high non-hyperaemic angiography-derived index of microcirculatory resistance (NH IMRangio > 43U) predict long-term adverse clinical outcomes in patients with STEMI post-pPCI?
NH IMRangio > 43U is prognostically equivalent to invasively measured IMR and independently predicts long-term adverse events in STEMI patients, offering a pressure-wire and adenosine-free alternative for risk stratification.
Hazard Ratio: 2.13 (95% CI 1.01–4.48)
p-value: p=0.047
Aims: Despite the prognostic value of coronary microvascular dysfunction (CMD) in patients with ST-segment-elevation myocardial infarction (STEMI), its assessment with pressure-wire-based methods remains limited due to cost, technical and procedural complexities. The non-hyperaemic angiography-derived index of microcirculatory resistance (NH IMR angio ) has been shown to reliably predict microvascular injury in patients with STEMI. We investigated the prognostic potential of NH IMR angio as a pressure-wire and adenosine-free tool. Methods and Results: NH IMR angio was retrospectively derived on the infarct-related artery at completion of primary percutaneous coronary intervention (pPCI) in 262 prospectively recruited STEMI patients. Invasive pressure-wire-based assessment of the index of microcirculatory resistance (IMR) was performed. The combination of all-cause mortality, resuscitated cardiac arrest and new heart failure was the primary endpoint. NH IMR angio showed good diagnostic performance in identifying CMD (IMR 40U); AUC 0.78 (95%CI: 0.72–0.84, p 0.0001) with an optimal cut-off at 43U. The primary endpoint occurred in 38 (16%) patients at a median follow-up of 4.2 (2.0–6.5) years. On survival analysis, NH IMR angio 43U (log-rank test, p 0.001) was equivalent to an IMR 40U(log-rank test, p = 0.02) in predicting the primary endpoint (hazard ratio comparison p = 0.91). NH IMRangio 43U was an independent predictor of the primary endpoint (adjusted HR 2.13, 95% CI: 1.01–4.48, p = 0.047). Conclusion: NH IMR angio is prognostically equivalent to invasively measured IMR and can be a feasible alternative to IMR for risk stratification in patients presenting with STEMI.
Kotronias et al. (Tue,) conducted a cohort in ST-segment-elevation myocardial infarction (STEMI) (n=262). NH IMRangio > 43U vs. NH IMRangio ≤ 43U was evaluated on Composite of all-cause mortality, resuscitated cardiac arrest, and new heart failure (adjusted HR 2.13, 95% CI 1.01-4.48, p=0.047). A non-hyperaemic angiography-derived index of microcirculatory resistance (NH IMRangio) > 43U independently predicted a composite of all-cause mortality, resuscitated cardiac arrest, and new heart failure (adjusted HR 2.13).