Prognostic Value of Coronary Angiography–Derived Index of Microcirculatory Resistance in Non–ST-Segment Elevation Myocardial Infarction Patients

作者：Yuxuan Zhang, Jun Pu, Tiesheng Niu, Jiacheng Fang, Delong Chen, Abuduwufuer Yidilisi, Yiyue Zheng, Jia Jie Lu, Yumeng Hu, Bon‐Kwon Koo, Jianping Xiang, Jianan Wang, Jun Jiang · 发表于：JACC: Cardiovascular Interventions · 年份：2024 · DOI：10.1016/j.jcin.2024.04.048 · 被引用次数：32 · 研究领域：Cardiac Imaging and Diagnostics、Coronary Interventions and Diagnostics、Cardiovascular Health and Disease Prevention

BACKGROUND: The index of microcirculatory resistance is a reliable measure for evaluating coronary microvasculature, but its prognostic value in patients with non-ST-segment elevation myocardial infarction (NSTEMI) remains unclear. OBJECTIVES: This study aimed to evaluate the prognostic impact of postpercutaneous coronary intervention (PCI) angiography-derived index of microcirculatory resistance (angio-IMR) in patients with NSTEMI. METHODS: The culprit vessel's angio-IMR was measured after PCI in 2,212 NSTEMI patients at 3 sites. The primary endpoint was 2-year major adverse cardiac events (MACEs), defined as a composite of cardiac death, readmission for heart failure, myocardial reinfarction, and target vessel revascularization. RESULTS: The mean post-PCI angio-IMR was 20.63 ± 4.17 in NSTEMI patients. A total of 206 patients were categorized as the high post-PCI angio-IMR group according to maximally selected log-rank statistics. Patients with angio-IMR >25 showed a higher rate of MACEs than those with angio-IMR ≤25 (32.52% vs 9.37%; P < 0.001). Post-PCI angio-IMR >25 was an independent predictor of MACEs (HR: 4.230; 95% CI: 3.151-5.679; P < 0.001) and showed incremental prognostic value compared with conventional risk factors (AUC: 0.774 vs 0.716; P < 0.001; net reclassification index: 0.317; P < 0.001; integrated discrimination improvement: 0.075; P < 0.001). CONCLUSIONS: In patients undergoing PCI for NSTEMI, an increased post-PCI angio-IMR is associated with a higher ri...