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. 2025 Dec;40(12):1079-1091.
doi: 10.1007/s00380-025-02575-x. Epub 2025 Jul 14.

Prognostic significance of angiography-derived index of microcirculatory resistance assessment after rotational atherectomy in patients with severely calcified lesions

Yuki Sakamoto  1 , Hiroyuki Kawamori  1 , Takayoshi Toba  1 , Satoru Sasaki  1 , Hiroyuki Fujii  1 , Tomoyo Hamana  1 , Yuto Osumi  1 , Seigo Iwane  1 , Tetsuya Yamamoto  1 , Shota Naniwa  1 , Koshi Matsuhama  1 , Yuta Fukuishi  1 , Hiroshi Tsunamoto  1 , Hiroya Okamoto  1 , Kotaro Higuchi  1 , Ken-Ichi Hirata  1 , Hiromasa Otake  2
Affiliations

Prognostic significance of angiography-derived index of microcirculatory resistance assessment after rotational atherectomy in patients with severely calcified lesions

Yuki Sakamoto et al. Heart Vessels. 2025 Dec.

Abstract

Coronary microcirculatory dysfunction (CMD) is a known predictor of adverse outcomes after percutaneous coronary intervention (PCI). However, the prognostic significance of CMD in patients with severely calcified lesions treated with rotational atherectomy (RA) remains unclear. We retrospectively studied consecutive chronic coronary syndrome patients who underwent PCI with RA followed by second-generation drug-eluting stent (DES) implantation. CMD was evaluated by angiography-derived index of microcirculatory resistance (IMRangio), calculated from the quantitative flow ratio (QFR) obtained immediately after PCI without hyperemia. The primary outcome was the occurrence of major adverse cardiovascular events (MACE) within 2 years, including cardiovascular death, spontaneous myocardial infarction, and target vessel revascularization. Among the 128 enrolled patients, 22 (17.2%) experienced MACE. Post-IMRangio was significantly higher in patients who experienced MACE than in those who did not (39.3 ± 12.5 vs. 30.4 ± 9.8, p < 0.001). Increased post-IMRangio was independently associated with MACE (hazard ratio, 1.05; 95% confidence interval [CI]: 1.02-1.09, p = 0.004). Receiver operating characteristic curve analysis identified optimal cutoff values of 40.6 for post-IMRangio to predict MACE (area under the curve 0.72, 95% CI: 0.58-0.86). Including high post-IMRangio (> 40U), along with clinical risk factors and QFR findings, significantly improved the discriminatory and reclassification ability to identify the risk of MACE after RA. IMRangio measured immediately after the PCI with RA followed by second-generation DES implantation is a valuable tool for risk stratification in patients with severely calcified lesions.

Keywords: Angiography-derived index of microcirculatory resistance; Coronary microcirculatory dysfunction; Rotational atherectomy.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that there is no conflict of interest.

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