Key result
High equivalent angiographic microvascular resistance is linked to ~2.3-fold higher 1-year major events in INOCA.
Why the study?
Patients with INOCA are at increased risk of adverse cardiovascular outcomes due to coronary microvascular dysfunction, but simple and accessible markers for prognostic assessment in this population remain limited.
Does elevated equivalent angiographic microvascular resistance (AMReq > 97 mmHg·s·m⁻¹) predict a higher risk of 1-year composite clinical outcomes in patients with ischemia and non-obstructive coronary artery disease (INOCA)?
Cohort (n=381)
Personnel responsible for data acquisition, statisticians performing analyses, and follow-up assessors were mutually blinded to each other's data; endpoint events adjudicated by two independent investigators blinded to AMR results
No
Does elevated equivalent angiographic microvascular resistance (AMReq > 97 mmHg·s·m⁻¹) predict a higher risk of 1-year composite clinical outcomes in patients with ischemia and non-obstructive coronary artery disease (INOCA)?
Hazard Ratio: 2.263 (95% CI 1.259–4.065)
p-value: p=0.006
Equivalent angiographic microvascular resistance (AMReq) derived from single-view coronary angiography is independently associated with 1-year adverse clinical outcomes (predominantly recurrent angina) in patients with INOCA, offering a wire-free tool for prognostic assessment.
High AMReq was associated with higher 1-year events in INOCA; extends wire-free microvascular assessment but leaves open its role in risk stratification.
Patients with ischemia with non-obstructive coronary artery disease (INOCA) are at increased risk of adverse cardiovascular outcomes, largely attributable to coronary microvascular dysfunction (CMD); however, simple and accessible markers for prognostic assessment in this population remain limited. This study aimed to evaluate the association between the angiographic microvascular resistance (AMR) and the 1-year composite clinical outcome in patients with INOCA. A total of 381 patients with non-obstructive coronary arteries who underwent coronary angiography (CAG) due to angina at the Department of Cardiology, Nanjing Drum Tower Hospital, between June 2022 and July 2024, were included in this prospective study. The AMR was calculated using the AngioPlus Core software. The primary endpoint was the 1-year composite clinical outcome predominantly driven by recurrent angina. Based on the median value of the equivalent AMR (AMR eq ), patients were categorized into high-AMR eq and low-AMR eq groups. Cox regression analysis, Kaplan–Meier survival curves, and restricted cubic spline (RCS) analysis were used to investigate the associations of single-vessel AMR and AMR eq with the prognosis of INOCA patients. During the 1 year follow-up period, 51 patients (13.4%) experienced the composite outcome, mainly driven by recurrent angina (11.8%), followed by non-fatal stroke (1.0%), and worsening heart failure (0.5%). The median value of AMR eq was 97 mmHg s m −1 . The high-AMR eq group exhibited a significantly higher hazard of the composite outcome compared with the low-AMR eq group ( P = 0.003). In the adjusted multivariable Cox proportional hazards model, AMR eq remained independently associated with the composite outcome ( HR = 2.263 , 95% CI 1.259–4.065 , P = 0.006). The RCS analysis demonstrated a positive linear relationship between AMR eq and the hazard of the composite outcome . Kaplan–Meier survival analysis indicated that patients with AMR eq > 97 mmHg s m −1 had a worse prognosis ( P = 0.003). AMR eq was independently associated with the 1 year composite clinical outcome in patients with INOCA, predominantly driven by recurrent angina. However, whether AMR eq improves risk stratification beyond single-vessel AMR remains to be established.
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Zhang et al. (2026) conducted a cohort in Ischemia with non-obstructive coronary artery disease (INOCA) (n=381). High equivalent angiographic microvascular resistance (AMReq > 97 mmHg·s·m⁻¹) vs. Low equivalent angiographic microvascular resistance (AMReq ≤ 97 mmHg·s·m⁻¹) was evaluated on 1-year composite clinical outcome of cardiac death, recurrent angina, non-fatal myocardial infarction, non-fatal stroke, and worsening heart failure (HR 2.263, 95% CI 1.259-4.065, p=0.006). High equivalent angiographic microvascular resistance (>97 mmHg·s·m⁻¹) was independently associated with a 2.26-fold higher hazard of 1-year composite clinical outcomes in INOCA patients (HR 2.263, 95% CI 1.259–4.065, P=0.006).
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