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Aim <p>This study aims to investigate the interplay between post-percutaneous coronary intervention (PCI) microvascular dysfunction and diabetes mellitus (DM) in patients with ST-segment elevation myocardial infarction (STEMI) and their combined impact on prognosis.</p> Methods <p>This retrospective study included 1,629 STEMI patients who successfully underwent PCI across three centers. Angio-IMR (angiography-derived index of microcirculatory resistance) was retrospectively measured. The primary endpoint was 2-year major adverse cardiac events (MACE), defined as a composite of cardiac death, readmission for heart failure, myocardial re-infarction, and target vessel revascularization.</p> Result <p>Among the 1,629 patients, 448(27.5%) had diabetes. Post-PCI angio-IMR value did not differ significantly between DM and non-DM group (33.04 [interquartile range (IQR) 22.20–43.20] vs. 32.02[IQR 22.57–41.60]; <i>P</i> = 0.420). Patients with post-PCI angio-IMR &gt; 40 had significantly higher rates of MACE, irrespective of diabetes status (DM group: 23.1% vs. 6.7%; <i>P</i> &lt; 0.001. Non-DM group: 19.0% vs. 4.8%; <i>P</i> &lt; 0.001. P for interaction = 0.771). Patients with both diabetes and angio-IMR &gt; 40 had the highest hazard ratio (HR) for MACE after adjustment (HR 5.076; 95% confidence interval, 3.157–8.161; <i>P</i> &lt; 0.001).</p> Conclusions <p>Post-PCI angio-IMR is an independent predictor of 2-year MACE in STEMI patients, regardless of diabetes status. Patients with both diabetes and post-PCI angio-IMR &gt; 40 had the highest 2-year adverse event rates, underscoring the need for targeted risk assessment and management.</p> Graphical abstract <p></p>

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Prognostic stratification of coronary microvascular dysfunction in STEMI patients with or without diabetes mellitus

  • 期刊论文

  • 发表日期：

    2025年11月3日

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  • Yiyue Zheng,
  • Abudushalamu Shadeerding,
  • Yuxuan Zhang,
  • Chenyun Zhang,
  • Abuduwufuer Yidilisi,
  • Tingting Mei,
  • Zining Chen,
  • Delong Chen,
  • Jiacheng Fang,
  • Rui Ji,
  • Xinyi Zhang,
  • Jianping Xiang,
  • Tiesheng Niu,
  • Jun Pu,
  • Jian’an Wang,
  • Jun Jiang

摘要

Aim

This study aims to investigate the interplay between post-percutaneous coronary intervention (PCI) microvascular dysfunction and diabetes mellitus (DM) in patients with ST-segment elevation myocardial infarction (STEMI) and their combined impact on prognosis.

Methods

This retrospective study included 1,629 STEMI patients who successfully underwent PCI across three centers. Angio-IMR (angiography-derived index of microcirculatory resistance) was retrospectively measured. The primary endpoint was 2-year major adverse cardiac events (MACE), defined as a composite of cardiac death, readmission for heart failure, myocardial re-infarction, and target vessel revascularization.

Result

Among the 1,629 patients, 448(27.5%) had diabetes. Post-PCI angio-IMR value did not differ significantly between DM and non-DM group (33.04 [interquartile range (IQR) 22.20–43.20] vs. 32.02[IQR 22.57–41.60]; P = 0.420). Patients with post-PCI angio-IMR > 40 had significantly higher rates of MACE, irrespective of diabetes status (DM group: 23.1% vs. 6.7%; P < 0.001. Non-DM group: 19.0% vs. 4.8%; P < 0.001. P for interaction = 0.771). Patients with both diabetes and angio-IMR > 40 had the highest hazard ratio (HR) for MACE after adjustment (HR 5.076; 95% confidence interval, 3.157–8.161; P < 0.001).

Conclusions

Post-PCI angio-IMR is an independent predictor of 2-year MACE in STEMI patients, regardless of diabetes status. Patients with both diabetes and post-PCI angio-IMR > 40 had the highest 2-year adverse event rates, underscoring the need for targeted risk assessment and management.

Graphical abstract