Angiography-Derived Microcirculatory Resistance in Detecting Microvascular Obstruction and Predicting Heart Failure After STEMI
Authors' conclusion
AMR showed good diagnostic performance in detecting MVO and was an independent and incremental predictor of HF in patients with ST-segment-elevation myocardial infarction post-primary percutaneous coronary intervention.
Study context
- Population
- Patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention with a cardiac magnetic resonance examination 2 to 7 days post-procedure, April 2016 to February 2023patients included (aged 56.8±11.7 years, 399 men)
- Participants
- 475 patients
- Exposure
- AMR computed from coronary angiography against microvascular obstruction (MVO) identified via cardiac magnetic resonance; AMR as a predictor of new-onset heart failure (HF)
- Outcome
- Detection of MVO by AMR
Main finding
As reported in the abstract
Area under the curve
0.821
95% CI 0.782–0.859
Optimal cutoff value
2.7 mm Hg*s/cm
Observational data: associations, not effects.
Further findings
| Outcome | Hazard ratio (per 0.5-mm Hg*s/cm increase) (95% CI) | P value | |
|---|---|---|---|
| Association of AMR with HFAMR (continuous) · adjusted | 1.29 (1.10–1.52) | P = 0.002 | |
| 0.512Hazard ratio (log scale) |
Association of AMR with HF
| Comparison | Hazard ratio (95% CI) | P value | |
|---|---|---|---|
| AMR >2.7 mm Hg*s/cmAdjusted | 2.15 (1.43–3.22) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
- Association of AMR with HF: adjusted for age, symptom-to-balloon time, left anterior descending coronary artery, ejection fraction and late gadolinium enhancement-cardiac magnetic resonance parameters
New-onset HF · median follow-up of 37.3 months
- Patients who developed HF
- 121 (25.5%)
Incremental prognostic value of AMR over traditional risk factors and late gadolinium enhancement-cardiac magnetic resonance parameters
- Net reclassification improvement (P <0.001)
- 0.533
- Integrative discrimination index (P =0.005)
- 0.023
Original publication
Angiography-Derived Microcirculatory Resistance in Detecting Microvascular Obstruction and Predicting Heart Failure After STEMI. Circ Cardiovasc Imaging. Published 3 April 2025. doi:10.
Summarised from the published abstract; every number is checked against it