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. 2022 Oct 29;21(1):222.
doi: 10.1186/s12933-022-01653-y.

Prognostic value of coronary microvascular dysfunction assessed by coronary angiography-derived index of microcirculatory resistance in diabetic patients with chronic coronary syndrome

Wen Zhang #  1 , Shekhar Singh #  1 , Lu Liu  1 , Abdul-Quddus Mohammed  1 , Guoqing Yin  1 , Siling Xu  1 , Xian Lv  1 , Tingting Shi  1 , Cailin Feng  1 , Rong Jiang  1 , Ayman A Mohammed  1 , Redhwan M Mareai  1 , Yawei Xu  1 , Xuejing Yu  2   3 , Fuad A Abdu  4 , Wenliang Che  5   6
Affiliations

Prognostic value of coronary microvascular dysfunction assessed by coronary angiography-derived index of microcirculatory resistance in diabetic patients with chronic coronary syndrome

Wen Zhang et al. Cardiovasc Diabetol. .

Abstract

Background: Coronary microvascular dysfunction (CMD) is common and is associated with unfavorable cardiovascular events in patients with diabetes mellitus (DM). Coronary angiography-derived index of microcirculatory resistance (caIMR) is a recently developed wire- and hyperemic agent-free method to assess CMD. We aimed to investigate the prognostic impact of CMD assessed by caIMR on clinical outcomes in patients with DM and chronic coronary syndrome (CCS).

Methods: CCS patients who underwent coronary angiography between June 2015 to May 2018 were included. Coronary microvascular function was measured by caIMR, and CMD was defined as caIMR ≥ 25U. The primary endpoint was major adverse cardiac events (MACE). Kaplan-Meier analysis and Cox proportional hazards models were used to assess the relationship between caIMR and the risk of MACE.

Results: Of 290 CCS patients, 102 patients had DM. Compared with non-diabetic patients, CMD (caIMR ≥ 25U) was higher among DM patients (57.8% vs. 38.3%; p = 0.001). During a mean 35 months follow-up, 40 MACE had occurred. Patients with caIMR ≥ 25 had a higher rate of MACE than patients with caIMR < 25 (20.6% vs. 8.2%, p = 0.002). Of these, the MACE rate was higher among DM patients with caIMR ≥ 25 than those with caIMR < 25 (33.9% vs. 14.0%; p = 0.022). In multivariable Cox analysis, caIMR ≥ 25 was independently associated with MACE in the DM patients but not in non-DM patients (HR, 2.760; 95% CI, 1.066-7.146; P = 0.036).

Conclusion: CMD assessed by caIMR was common and is an independent predictor of MACE among diabetic patients with CCS. This finding potentially enables a triage of higher-risk patients to more intensive therapy.

Keywords: Chronic coronary syndrome; Coronary angiography‑derived index of microvascular resistance; Coronary microvascular dysfunction; Diabetes mellitus; Outcome.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of the study selection process. CAG, coronary angiography; CCS, chronic coronary syndrome; caIMR, coronary angiography-derived index of microcirculatory resistance; DM, diabetes mellitus
Fig. 2
Fig. 2
Scatter plot of caIMR between DM patients and those without DM. caIMR: coronary angiography‑derived index of microcirculatory resistance
Fig. 3
Fig. 3
Rate of MACE among total, DM and non-DM patients according to caIMR. caIMR, coronary angiography-derived index of microcirculatory resistance; MACE, major adverse cardiac events
Fig. 4
Fig. 4
(A) Kaplan-Meier survival curves of MACE in CCS patients according to caIMR; (B) Kaplan-Meier survival curves of ischemia-driven revascularization in CCS patients according to caIMR; (C) Kaplan-Meier survival curves of heart failure in CCS patients according to caIMR. caIMR, coronary angiography-derived index of microcirculatory resistance
Fig. 5
Fig. 5
(A) Kaplan-Meier survival curves of MACE in DM patients with CCS according to caIMR; (B) Kaplan-Meier survival curves of MACE in non-DM patients with CCS according to caIMR. DM, diabetes mellitus; caIMR, coronary angiography-derived index of microcirculatory resistance
See this image and copyright information in PMC

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