Comparative Prognostic Utility of Indexes of Microvascular Function Alone or in Combination in Patients With an Acute ST-Segment–Elevation Myocardial Infarction
Main finding · All-cause death or HFResult — go to the resultOdds ratio 4.36 95% CI 2.10–9.06Authors' conclusion
An IMR>40 is a multivariable associate of left ventricular and clinical outcomes after ST-segment-elevation myocardial infarction independently of the infarction size.
Study context
- Population
- Patients with acute STEMI undergoing emergency PCI
- Participants
- 283 patients
- Exposure
- Index of microvascular resistance (IMR)>40 vs IMR≤40
- Outcome
- All-cause death or first HF hospitalization (prespecified outcome)
- Follow-up
- Median , 845 days
Methodological detailsprespecified outcome, CMR at 2 days and 6 months after MI
- Prespecified outcome
- CMR at 2 days and 6 months after MI
Main finding
All-cause death or HF
Odds ratio
4.36
95% CI 2.10–9.06
P < 0.001
IMR>40 vs IMR≤40
OR 4.36 (95% CI 2.10–9.06); P < 0.001
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Myocardial hemorrhage (CMR)IMR>40 vs IMR≤40 · multivariable | 2.10 (1.03–4.27) | P = 0.042 | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | Coefficient (95% CI) | P value |
|---|---|---|
| Change in LVEF · 6 monthsIMR>40 vs IMR≤40 · multivariable, independent of infarct size | −2.12 (−4.02 to −0.23) | P = 0.028 |
| Change in LV end-diastolic volume · 6 monthsIMR>40 vs IMR≤40 · multivariable, independent of infarct size | 7.85 (0.41–15.29) | P = 0.039 |
Median IMR and CFR (all patients)
- Median IMR 25 (IQR 15-48)
- Median CFR 1.6 (IQR 1.1-2.1)
Myocardial hemorrhage (CMR)
- IMR>40 closely associated with microvascular obstruction; symptom-to-reperfusion time, TIMI blush grade and no (≤30%) ST-segment resolution not associated with these pathologies
Original publication
Comparative Prognostic Utility of Indexes of Microvascular Function Alone or in Combination in Patients With an Acute ST-Segment–Elevation Myocardial Infarction. Circulation. Published 1 November 2016. doi:10.
Summarised from the published abstract; every number is checked against it