Key result
Post-PCI angiography-based index of microcirculatory resistance demonstrated moderate diagnostic performance for detecting microvascular obstruction (AUC 0.750, p<0.001).
Why the study?
The effect of thrombolysis on post-PCI angio-IMR, and its associations with MVO and IS, remains unclear.
Does angiography-based index of microcirculatory resistance (angio-IMR) correlate with microvascular obstruction and infarct size, and does pre-PCI recombinant staphylokinase reduce these parameters in STEMI patients?
Cohort (n=123)
Blinded core laboratory analysis
Yes
Does angiography-based index of microcirculatory resistance (angio-IMR) correlate with microvascular obstruction and infarct size, and does pre-PCI recombinant staphylokinase reduce these parameters in STEMI patients?
Post-PCI angiography-based index of microcirculatory resistance (angio-IMR) correlates significantly with microvascular obstruction and infarct size, suggesting its utility as a wire-free diagnostic tool for assessing microvascular injury in STEMI patients.
May support post-PCI MVO assessment in STEMI; leaves open validation against CMR before practice adoption.
Objectives To evaluate angiography‐based index of microcirculatory resistance (angio‐IMR) in assessing microvascular obstruction (MVO) and infarct size (IS) in ST‐segment elevation myocardial infarction (STEMI). Background The effect of thrombolysis on post‐percutaneous coronary intervention (PCI) angio‐IMR, and its associations with MVO and IS remains unclear. Methods One hundred twenty‐three STEMI patients randomized to receive 5 mg intravenous bolus of recombinant staphylokinase (r‐SAK) or normal saline (NS) before PCI were recruited. Angio‐IMR was computed in infarct‐related arteries. MVO and IS were detected by cardiac magnetic resonance imaging. Results Compared with NS group, r‐SAK group exhibited numerically lower post‐PCI angio‐IMR (39.12 U vs. 42.57 U; p = 0.567), MVO (54.0% vs. 70.9%; p = 0.059), MVO extent (0.70% vs. 1.90%; p = 0.101) and IS (21.30% vs. 24.50%; p = 0.079). Post‐PCI angio‐IMR was positively correlated with MVO extent ( ρ = 0.347; p < 0.001) and IS ( ρ = 0.324; p < 0.001). Receiver operating characteristic analyses showed moderate diagnostic performance of angio‐IMR for MVO (area under the curve [AUC] = 0.750; p < 0.001), MVO > 2.6% (AUC = 0.735; p < 0.001) and IS > 25% (AUC = 0.712; p < 0.001). The exploratory optimal cut‐off values for these endpoints were approximately 40 U. Conclusions In STEMI patients, a single bolus of r‐SAK before PCI was associated with numeric reductions in post‐PCI angio‐IMR, MVO, MVO extent and IS. Additionally, angio‐IMR exhibited a significantly positive correlation with both MVO extent and IS, demonstrating the diagnostic value of this wire‐free method for assessing microvascular injury.
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Wu et al. (2026) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=123). Angiography-based index of microcirculatory resistance (angio-IMR) was evaluated on Microvascular obstruction (MVO) (AUC 0.750, 95% CI 0.662-0.825, p=<0.001). Post-PCI angiography-based index of microcirculatory resistance demonstrated moderate diagnostic performance for detecting microvascular obstruction (AUC 0.750, p<0.001).
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