Elevated angiography-derived microvascular resistance and HbA1c levels jointly predict adverse outcomes in patients with diabetic STEMI: a multicenter retrospective cohort study.
Research on coronary microcirculatory function in type 2 diabetes mellitus (T2DM) patients with ST-segment elevation myocardial infarction (STEMI) remains limited.
Patients diagnosed with new-onset STEMI between January 2022 and December 2023 were enrolled. All underwent culprit vessel revascularization, with simultaneous blood sampling and angiography-derived microvascular resistance (AMR) assessment in the reperfused vessel. The primary endpoint was the incidence of major adverse cardiovascular and cerebrovascular events (MACCEs).
A total of 545 patients were divided into four groups based on HbA1c and AMR levels. After adjustment for covariates using a multivariable Cox proportional hazards model, HbA1c (HR = 1.403, 95% CI: 1.131-1.740), AMR (HR = 1.213, 95% CI: 1.105-1.520), and NT-proBNP (HR = 1.244, 95% CI: 1.1053-2.868) remained independently associated with MACCEs. Patients with HbA1c ≥6.5% and AMR ≥250.5 mmHg·s/m exhibited the highest risk of MACCEs (HR = 6.903, 95% CI:3.260-14.618, P < 0.001). Restricted cubic spline analysis revealed nonlinear relationships between MACCEs and both HbA1c and AMR levels. RCS analysis indicated nonlinear relationships between MACCEs incidence and both HbA1c and AMR levels.
This study demonstrates that an elevated AMR following PCI independently predicts MACCEs in patients with STEMI and T2DM. Combined evaluation of AMR and HbA1c enhances risk stratification for MACCEs. Assessment of coronary microcirculatory function and sustained optimization of glycemic control may contribute to improved long-term clinical outcomes in this population.
Patients diagnosed with new-onset STEMI between January 2022 and December 2023 were enrolled. All underwent culprit vessel revascularization, with simultaneous blood sampling and angiography-derived microvascular resistance (AMR) assessment in the reperfused vessel. The primary endpoint was the incidence of major adverse cardiovascular and cerebrovascular events (MACCEs).
A total of 545 patients were divided into four groups based on HbA1c and AMR levels. After adjustment for covariates using a multivariable Cox proportional hazards model, HbA1c (HR = 1.403, 95% CI: 1.131-1.740), AMR (HR = 1.213, 95% CI: 1.105-1.520), and NT-proBNP (HR = 1.244, 95% CI: 1.1053-2.868) remained independently associated with MACCEs. Patients with HbA1c ≥6.5% and AMR ≥250.5 mmHg·s/m exhibited the highest risk of MACCEs (HR = 6.903, 95% CI:3.260-14.618, P < 0.001). Restricted cubic spline analysis revealed nonlinear relationships between MACCEs and both HbA1c and AMR levels. RCS analysis indicated nonlinear relationships between MACCEs incidence and both HbA1c and AMR levels.
This study demonstrates that an elevated AMR following PCI independently predicts MACCEs in patients with STEMI and T2DM. Combined evaluation of AMR and HbA1c enhances risk stratification for MACCEs. Assessment of coronary microcirculatory function and sustained optimization of glycemic control may contribute to improved long-term clinical outcomes in this population.
Authors
Gao Gao, Wang Wang, Wang Wang, Zeng Zeng, Cheng Cheng, Han Han, Wang Wang, Li Li, Hu Hu
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