Angiography-Derived Index of Microcirculatory Resistance to Define the Risk of Early Discharge in STEMI

• Published in: Circulation. Cardiovascular interventions Vol. 17; no. 3; p. e013556
• Main Authors: Scarsini, Roberto, Kotronias, Rafail A, Della Mora, Francesco, Portolan, Leonardo, Andreaggi, Stefano, Benenati, Stefano, Marin, Federico, Sgreva, Sara, Comuzzi, Alberto, Butturini, Caterina, Pesarini, Gabriele, Tavella, Domenico, Channon, Keith M, Garcia Garcia, Hector M, Ribichini, Flavio, Banning, Adrian P, De Maria, Giovanni Luigi
• Format: Journal Article
• Language: English
• Published: United States 01.03.2024
• Subjects: Coronary Angiography; Coronary Vessels - diagnostic imaging; Heart Failure - etiology; Humans; Microcirculation; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - etiology; Myocardial Infarction - therapy; Patient Discharge; Percutaneous Coronary Intervention - adverse effects; Prospective Studies; Retrospective Studies; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - etiology; ST Elevation Myocardial Infarction - therapy; Treatment Outcome; coronary microvascular injury; early discharge; microcirculation; ST-segment–elevation myocardial infarction; coronary angiography; myocardial infarction
• ISSN: 1941-7640; 1941-7632
• DOI: 10.1161/CIRCINTERVENTIONS.123.013556

Patients with ST-segment-elevation myocardial infarction but no coronary microvascular injury are at low risk of early cardiovascular complications (ECC). We aim to assess whether nonhyperemic angiography-derived index of microcirculatory resistance (NH-IMR ) could be a user-friendly tool to identify patients at low risk of ECC, potentially candidates for expedited care pathway and early hospital discharge. Retrospective analysis of 2 independent, international, prospective, observational cohorts included 568 patients with ST-segment-elevation myocardial infarction. NH-IMR was calculated based on standard coronary angiographic views with 3-dimensional-modeling and computational analysis of the coronary flow. Overall, ECC (a composite of cardiovascular death, cardiogenic shock, acute heart failure, life-threatening arrhythmias, resuscitated cardiac arrest, left ventricular thrombus, post-ST-segment-elevation myocardial infarction mechanical complications, and rehospitalization for acute heart failure or acute myocardial infarction at 30 days follow-up), occurred in 54 (9.3%) patients. NH-IMR was significantly correlated with pressure/thermodilution-based index of microcirculatory resistance (r=0.607; <0.0001) and demonstrated good accuracy in predicting ECC (area under the curve, 0.766 [95% CI, 0.706-0.827]; <0.0001). Importantly, ECC occurred more frequently in patients with NH-IMR ≥40 units (18.1% versus 1.4%; <0.0001). At multivariable analysis, NH-IMR provided incremental prognostic value to conventional clinical, angiographic, and echocardiographic features (adjusted-odds ratio, 14.861 [95% CI, 5.177-42.661]; <0.0001). NH-IMR <40 units showed an excellent negative predictive value (98.6%) in ruling out ECC. Discharging patients with NH-IMR <40 units at 48 hours after admission would reduce the total in-hospital stay by 943 days (median 2 [1-4] days per patient). NH-IMR is a valuable risk-stratification tool in patients with ST-segment-elevation myocardial infarction. NH-IMR guided strategies to early discharge may contribute to safely shorten hospital stay, optimizing resources utilization.