Highlights
- lThe present study is the first to evaluate the prognostic value of coronary angiography‑derived index of microvascular resistance (caIMR) in MINOCA patients.
- lcaIMR had a good diagnostic performance to predict future MACE in MINOCA patients.
- lThe evaluation of the IMR can provide an objective risk stratification method for patients with MINOCA, which should be considered in the MINOCA population.
Abstract
Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) has been and
remained a puzzling heterogeneous entity. The index of microcirculatory resistance
(IMR) is a quantitative and specific index for the assessment of microvascular function.
However, the role of IMR in MINOCA has not yet been studied. This study aimed to evaluate
the prognostic value of coronary microvascular function, as assessed by coronary angiography‑derived
index of microvascular resistance (caIMR) in MINOCA patients.
Method
This study included 109 MINOCA patients. Microvascular function was assessed by caIMR
and was analyzed in 280 coronary arteries. The primary endpoint of the study was MACE,
defined as cardiovascular death, nonfatal MI, heart failure, stroke and angina rehospitalization.
The best cut-off of caIMR was derived from ROC analysis based on MACE prediction.
Results
The patients were classified into high caIMR (caIMR>43U) and low caIMR (caIMR≤43U)
based on a caIMR cut-off value of 43U. High caIMR was observed in 55 (50.5%) patients.
A total of 27 MACE occurred during the 2 years of follow-up. MACE rate was significantly
higher in patients with high caIMR than in patients with low caIMR (36.4% vs 13.0%,
P=0.005). The Kaplan–Meier curves showed a significantly increased risk of MACE in
patients with high caIMR (log-rank P=0.001). Cox multivariate analysis showed that
caIMR>43 was a highly independent predictor of MACE (HR, 3.08; 95% CI, 1.13 - 8.35;
P=0.027).
Conclusions
caIMR is a strong predictor of clinical outcome among MINOCA patients. The evaluation
of IMR can provide an objective risk stratification method for patients with MINOCA.
Graphic abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: June 03, 2021
Accepted:
May 16,
2021
Received in revised form:
May 11,
2021
Received:
February 25,
2021
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
