{"title":"用新的血管造影衍生的微血管阻力指数评价心肌梗死患者冠状动脉微血管功能障碍对预后的影响。","authors":"Benoit Caullery , Laurent Riou , Stephanie Marliere , Estelle Vautrin , Nicolas Piliero , Olivier Ormerzzano , Helene Bouvaist , Gerald Vanzetto , Gilles Barone-Rochette","doi":"10.1016/j.ijcha.2024.101575","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Several methods for measuring IMR derived from angiography have been developed. AngioIMR is a novel method for the assessment of angiography-derived IMR with no requirement for a wire and hyperemia. The prognostic value of AngioIMR is unknown in STEMI patients. We aimed to provide the prognostic value of AngioIMR in patients with ST-elevation myocardial infarction (STEMI).</div></div><div><h3>Methods</h3><div>This study included patients with STEMI who underwent invasive coronary angiography and primary percutaneous coronary intervention (PPCI). AngioIMR was calculated using computational flow and pressure simulation immediately after PPCI. The presence of significant coronary microvascular dysfunction was defined as AngioIMR > 40. The primary outcome was a composite of all cause death or hospitalization for heart failure (MACE).</div></div><div><h3>Results</h3><div>A total of 178 patients were included (65.0 ± 12.8 years on average, 74 % male gender). An AngioIMR > 40 was found in 72 patients. During a median follow-up of 2.9 (2.3–6.9) years, a primary endpoint was observed in 56 patients. By Kaplan-Meier analysis, the risk of MACE was significantly higher in patients with AngioIMR > 40 (log-rank P < 0.01). An Angio IMR > 40 was significantly associated with the occurrence of the primary endpoint in univariate (70 % vs 27 %; hazard ratio 4.519; 95 % CI: 2.550–8.009; p < 0.0001) and multivariate analysis (Hazard ratio 4.282; 95 % CI: 2.325–7.886; p < 0.0001). AngioIMR model showed incremental prognostic value compared to a model with clinical and imaging risk predictors (C-index 0.84 vs 0.79; p = 0.04).</div></div><div><h3>Conlusion</h3><div>Elevated AngioIMR showed a independent prognostic significance in STEMI patients. In addition to well-known risk factors, assessment of coronary microvascular dysfunction can be a feasible approach for early prevention and a therapeutic target in STEMI patients.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"56 ","pages":"Article 101575"},"PeriodicalIF":2.5000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665694/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prognostic impact of coronary microvascular dysfunction in patients with myocardial infarction evaluated by new angiography-derived index of microvascular resistance\",\"authors\":\"Benoit Caullery , Laurent Riou , Stephanie Marliere , Estelle Vautrin , Nicolas Piliero , Olivier Ormerzzano , Helene Bouvaist , Gerald Vanzetto , Gilles Barone-Rochette\",\"doi\":\"10.1016/j.ijcha.2024.101575\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Several methods for measuring IMR derived from angiography have been developed. AngioIMR is a novel method for the assessment of angiography-derived IMR with no requirement for a wire and hyperemia. The prognostic value of AngioIMR is unknown in STEMI patients. We aimed to provide the prognostic value of AngioIMR in patients with ST-elevation myocardial infarction (STEMI).</div></div><div><h3>Methods</h3><div>This study included patients with STEMI who underwent invasive coronary angiography and primary percutaneous coronary intervention (PPCI). AngioIMR was calculated using computational flow and pressure simulation immediately after PPCI. The presence of significant coronary microvascular dysfunction was defined as AngioIMR > 40. The primary outcome was a composite of all cause death or hospitalization for heart failure (MACE).</div></div><div><h3>Results</h3><div>A total of 178 patients were included (65.0 ± 12.8 years on average, 74 % male gender). An AngioIMR > 40 was found in 72 patients. During a median follow-up of 2.9 (2.3–6.9) years, a primary endpoint was observed in 56 patients. By Kaplan-Meier analysis, the risk of MACE was significantly higher in patients with AngioIMR > 40 (log-rank P < 0.01). An Angio IMR > 40 was significantly associated with the occurrence of the primary endpoint in univariate (70 % vs 27 %; hazard ratio 4.519; 95 % CI: 2.550–8.009; p < 0.0001) and multivariate analysis (Hazard ratio 4.282; 95 % CI: 2.325–7.886; p < 0.0001). AngioIMR model showed incremental prognostic value compared to a model with clinical and imaging risk predictors (C-index 0.84 vs 0.79; p = 0.04).</div></div><div><h3>Conlusion</h3><div>Elevated AngioIMR showed a independent prognostic significance in STEMI patients. In addition to well-known risk factors, assessment of coronary microvascular dysfunction can be a feasible approach for early prevention and a therapeutic target in STEMI patients.</div></div>\",\"PeriodicalId\":38026,\"journal\":{\"name\":\"IJC Heart and Vasculature\",\"volume\":\"56 \",\"pages\":\"Article 101575\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665694/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"IJC Heart and Vasculature\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2352906724002410\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"IJC Heart and Vasculature","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352906724002410","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：已经开发了几种测量血管造影术中IMR的方法。AngioIMR是一种评估血管造影衍生IMR的新方法，不需要导线和充血。血管imr对STEMI患者的预后价值尚不清楚。我们的目的是提供血管imr在st段抬高型心肌梗死（STEMI）患者中的预后价值。方法：本研究纳入了行有创冠状动脉造影和初级经皮冠状动脉介入治疗（PPCI）的STEMI患者。在PPCI后立即用计算流和压力模拟计算AngioIMR。存在明显的冠状动脉微血管功能障碍定义为AngioIMR bb40。主要结局是全因死亡或心力衰竭住院（MACE）的综合结果。结果：共纳入178例患者（平均年龄65.0±12.8岁，男性占74%）。72例患者发现血管imr bbb40。在中位随访2.9（2.3-6.9）年期间，56例患者观察到主要终点。Kaplan-Meier分析显示，血管imr为bb40的患者发生MACE的风险显著增高（log-rank P < 0.01）。在单变量中，血管IMR bb40与主要终点的发生显著相关(70% vs 27%；风险比4.519；95% ci: 2.550-8.009；结论：血管imr升高在STEMI患者中具有独立的预后意义。除了已知的危险因素外，评估冠状动脉微血管功能障碍可作为STEMI患者早期预防的可行方法和治疗靶点。
Prognostic impact of coronary microvascular dysfunction in patients with myocardial infarction evaluated by new angiography-derived index of microvascular resistance
Background
Several methods for measuring IMR derived from angiography have been developed. AngioIMR is a novel method for the assessment of angiography-derived IMR with no requirement for a wire and hyperemia. The prognostic value of AngioIMR is unknown in STEMI patients. We aimed to provide the prognostic value of AngioIMR in patients with ST-elevation myocardial infarction (STEMI).
Methods
This study included patients with STEMI who underwent invasive coronary angiography and primary percutaneous coronary intervention (PPCI). AngioIMR was calculated using computational flow and pressure simulation immediately after PPCI. The presence of significant coronary microvascular dysfunction was defined as AngioIMR > 40. The primary outcome was a composite of all cause death or hospitalization for heart failure (MACE).
Results
A total of 178 patients were included (65.0 ± 12.8 years on average, 74 % male gender). An AngioIMR > 40 was found in 72 patients. During a median follow-up of 2.9 (2.3–6.9) years, a primary endpoint was observed in 56 patients. By Kaplan-Meier analysis, the risk of MACE was significantly higher in patients with AngioIMR > 40 (log-rank P < 0.01). An Angio IMR > 40 was significantly associated with the occurrence of the primary endpoint in univariate (70 % vs 27 %; hazard ratio 4.519; 95 % CI: 2.550–8.009; p < 0.0001) and multivariate analysis (Hazard ratio 4.282; 95 % CI: 2.325–7.886; p < 0.0001). AngioIMR model showed incremental prognostic value compared to a model with clinical and imaging risk predictors (C-index 0.84 vs 0.79; p = 0.04).
Conlusion
Elevated AngioIMR showed a independent prognostic significance in STEMI patients. In addition to well-known risk factors, assessment of coronary microvascular dysfunction can be a feasible approach for early prevention and a therapeutic target in STEMI patients.
期刊介绍：
IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.
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