Prognostic Value of Coronary Angiography-Derived Index of Microcirculatory Resistance in Patients With Intermediate Coronary Stenosis

Yiyue Zheng; Yuxuan Zhang; Delong Chen; Abuduwufuer Yidilisi; Jiacheng Fang; Xinyi Zhang; Jicaidan Dao; Xinyang Hu; Jinlong Zhang; Die Hu; Airong Fu; Shiqiang Li; Seokhun Yang; Jeehoon Kang; Doyeon Hwang; Joo Yong Hahn; Chang Wook Nam; Joon Hyung Doh; Bong Ki Lee; Weon Kim; Jinyu Huang; Fan Jiang; Hao Zhou; Peng Chen; Lijiang Tang; Wenbing Jiang; Xiaomin Chen; Wenming He; Sung Gyun Ahn; Myeong Ho Yoon; Ung Kim; Joo Myung Lee; You Jeong Ki; Eun Seok Shin; Chee Hae Kim; Jianping Xiang; Seung Jea Tahk; Bon Kwon Koo; Jian'an Wang; Jun Jiang

doi:10.1016/j.jcin.2024.10.017

Prognostic Value of Coronary Angiography-Derived Index of Microcirculatory Resistance in Patients With Intermediate Coronary Stenosis

Yiyue Zheng, Yuxuan Zhang, Delong Chen, Abuduwufuer Yidilisi, Jiacheng Fang, Xinyi Zhang, Jicaidan Dao, Xinyang Hu, Jinlong Zhang, Die Hu, Airong Fu, Shiqiang Li, Seokhun Yang, Jeehoon Kang, Doyeon Hwang, Joo Yong Hahn, Chang Wook Nam, Joon Hyung Doh, Bong Ki Lee, Weon KimJinyu Huang, Fan Jiang, Hao Zhou, Peng Chen, Lijiang Tang, Wenbing Jiang, Xiaomin Chen, Wenming He, Sung Gyun Ahn, Myeong Ho Yoon, Ung Kim, Joo Myung Lee, You Jeong Ki, Eun Seok Shin, Chee Hae Kim, Jianping Xiang, Seung Jea Tahk, Bon Kwon Koo, Jian'an Wang, Jun Jiang

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: The association between coronary microcirculation and clinical outcomes in patients with intermediate stenosis remains unclear. Objectives: The aim of this study was to assess the prognostic significance of angiography-derived index of microcirculatory resistance (angio-IMR) in patients with intermediate coronary stenosis. Methods: This post hoc analysis included 1,658 patients from the FLAVOUR (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients with Intermediate Stenosis) trial, with angio-IMR measured in each vessel exhibiting intermediate stenosis. The primary endpoint was a patient-oriented composite outcome (POCO), a composite of all-cause death, myocardial infarction, or revascularization over a 2-year period. Results: The median follow-up period was 24.8 months (Q1-Q3: 24.4-26.4 months). Over the 2-year follow-up period, patients with angio-IMR >25 exhibited a significantly higher POCO rate in both the percutaneous coronary intervention (PCI) group (35.06% [27 of 77] vs 7.2% [51 of 708]; P < 0.001) and the non-PCI group (17.95% [21 of 117] vs 4.23% [32 of 756]; P < 0.001). After adjusting for potentially related risk factors, angio-IMR >25 remained an independent predictor of the POCO in the PCI group (HR: 6.235; 95% CI: 3.811-10.203; P < 0.001) and the non-PCI group (HR: 5.282; 95% CI: 2.948-9.462; P < 0.001). The addition of angio-IMR demonstrated incremental prognostic value in both an angiographic risk factor model (C-index 0.710 [95% CI: 0.663-0.756] vs 0.615 [95% CI: 0.563-0.664] [P < 0.001]; net reclassification index 0.268 [95% CI: 0.191-0.362; P < 0.001]; integrated discrimination improvement 0.055 [95% CI: 0.030-0.108; P < 0.001]) and a clinical risk factor model (C-index 0.705 [95% CI: 0.658-0.751] vs 0.594 [95% CI: 0.544-0.644] [P < 0.001]; net reclassification index 0.268 [95% CI: 0.171-0.350; P < 0.001]; integrated discrimination improvement 0.057 [95% CI: 0.027-0.102; P < 0.001]). Conclusions: In individuals with intermediate coronary stenosis, elevated angio-IMR is linked to an adverse prognosis. Using angio-IMR significantly enhanced the capability to reclassify patients and accurately estimate the risk for the POCO.

Original language	English
Pages (from-to)	171-183
Number of pages	13
Journal	JACC: Cardiovascular Interventions
Volume	18
Issue number	2
DOIs	https://doi.org/10.1016/j.jcin.2024.10.017
Publication status	Published - 27 Jan 2025

Bibliographical note

Publisher Copyright:
© 2025 The Authors

Keywords

coronary angiography
index of microcirculatory resistance
intermediate coronary stenosis
microcirculation
prognosis

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10.1016/j.jcin.2024.10.017

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Zheng, Y., Zhang, Y., Chen, D., Yidilisi, A., Fang, J., Zhang, X., Dao, J., Hu, X., Zhang, J., Hu, D., Fu, A., Li, S., Yang, S., Kang, J., Hwang, D., Hahn, J. Y., Nam, C. W., Doh, J. H., Lee, B. K., ... Jiang, J. (2025). Prognostic Value of Coronary Angiography-Derived Index of Microcirculatory Resistance in Patients With Intermediate Coronary Stenosis. JACC: Cardiovascular Interventions, 18(2), 171-183. https://doi.org/10.1016/j.jcin.2024.10.017

@article{ed863c1298df4c6abef3f70fad938cee,

title = "Prognostic Value of Coronary Angiography-Derived Index of Microcirculatory Resistance in Patients With Intermediate Coronary Stenosis",

abstract = "Background: The association between coronary microcirculation and clinical outcomes in patients with intermediate stenosis remains unclear. Objectives: The aim of this study was to assess the prognostic significance of angiography-derived index of microcirculatory resistance (angio-IMR) in patients with intermediate coronary stenosis. Methods: This post hoc analysis included 1,658 patients from the FLAVOUR (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients with Intermediate Stenosis) trial, with angio-IMR measured in each vessel exhibiting intermediate stenosis. The primary endpoint was a patient-oriented composite outcome (POCO), a composite of all-cause death, myocardial infarction, or revascularization over a 2-year period. Results: The median follow-up period was 24.8 months (Q1-Q3: 24.4-26.4 months). Over the 2-year follow-up period, patients with angio-IMR >25 exhibited a significantly higher POCO rate in both the percutaneous coronary intervention (PCI) group (35.06% [27 of 77] vs 7.2% [51 of 708]; P < 0.001) and the non-PCI group (17.95% [21 of 117] vs 4.23% [32 of 756]; P < 0.001). After adjusting for potentially related risk factors, angio-IMR >25 remained an independent predictor of the POCO in the PCI group (HR: 6.235; 95% CI: 3.811-10.203; P < 0.001) and the non-PCI group (HR: 5.282; 95% CI: 2.948-9.462; P < 0.001). The addition of angio-IMR demonstrated incremental prognostic value in both an angiographic risk factor model (C-index 0.710 [95% CI: 0.663-0.756] vs 0.615 [95% CI: 0.563-0.664] [P < 0.001]; net reclassification index 0.268 [95% CI: 0.191-0.362; P < 0.001]; integrated discrimination improvement 0.055 [95% CI: 0.030-0.108; P < 0.001]) and a clinical risk factor model (C-index 0.705 [95% CI: 0.658-0.751] vs 0.594 [95% CI: 0.544-0.644] [P < 0.001]; net reclassification index 0.268 [95% CI: 0.171-0.350; P < 0.001]; integrated discrimination improvement 0.057 [95% CI: 0.027-0.102; P < 0.001]). Conclusions: In individuals with intermediate coronary stenosis, elevated angio-IMR is linked to an adverse prognosis. Using angio-IMR significantly enhanced the capability to reclassify patients and accurately estimate the risk for the POCO.",

keywords = "coronary angiography, index of microcirculatory resistance, intermediate coronary stenosis, microcirculation, prognosis",

author = "Yiyue Zheng and Yuxuan Zhang and Delong Chen and Abuduwufuer Yidilisi and Jiacheng Fang and Xinyi Zhang and Jicaidan Dao and Xinyang Hu and Jinlong Zhang and Die Hu and Airong Fu and Shiqiang Li and Seokhun Yang and Jeehoon Kang and Doyeon Hwang and Hahn, {Joo Yong} and Nam, {Chang Wook} and Doh, {Joon Hyung} and Lee, {Bong Ki} and Weon Kim and Jinyu Huang and Fan Jiang and Hao Zhou and Peng Chen and Lijiang Tang and Wenbing Jiang and Xiaomin Chen and Wenming He and Ahn, {Sung Gyun} and Yoon, {Myeong Ho} and Ung Kim and Lee, {Joo Myung} and Ki, {You Jeong} and Shin, {Eun Seok} and Kim, {Chee Hae} and Jianping Xiang and Tahk, {Seung Jea} and Koo, {Bon Kwon} and Jian'an Wang and Jun Jiang",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = jan,

day = "27",

doi = "10.1016/j.jcin.2024.10.017",

language = "English",

volume = "18",

pages = "171--183",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "2",

}

Zheng, Y, Zhang, Y, Chen, D, Yidilisi, A, Fang, J, Zhang, X, Dao, J, Hu, X, Zhang, J, Hu, D, Fu, A, Li, S, Yang, S, Kang, J, Hwang, D, Hahn, JY, Nam, CW, Doh, JH, Lee, BK, Kim, W, Huang, J, Jiang, F, Zhou, H, Chen, P, Tang, L, Jiang, W, Chen, X, He, W, Ahn, SG, Yoon, MH, Kim, U, Lee, JM, Ki, YJ, Shin, ES, Kim, CH, Xiang, J, Tahk, SJ, Koo, BK, Wang, J & Jiang, J 2025, 'Prognostic Value of Coronary Angiography-Derived Index of Microcirculatory Resistance in Patients With Intermediate Coronary Stenosis', JACC: Cardiovascular Interventions, vol. 18, no. 2, pp. 171-183. https://doi.org/10.1016/j.jcin.2024.10.017

TY - JOUR

T1 - Prognostic Value of Coronary Angiography-Derived Index of Microcirculatory Resistance in Patients With Intermediate Coronary Stenosis

AU - Zheng, Yiyue

AU - Zhang, Yuxuan

AU - Chen, Delong

AU - Yidilisi, Abuduwufuer

AU - Fang, Jiacheng

AU - Zhang, Xinyi

AU - Dao, Jicaidan

AU - Hu, Xinyang

AU - Zhang, Jinlong

AU - Hu, Die

AU - Fu, Airong

AU - Li, Shiqiang

AU - Yang, Seokhun

AU - Kang, Jeehoon

AU - Hwang, Doyeon

AU - Hahn, Joo Yong

AU - Nam, Chang Wook

AU - Doh, Joon Hyung

AU - Lee, Bong Ki

AU - Kim, Weon

AU - Huang, Jinyu

AU - Jiang, Fan

AU - Zhou, Hao

AU - Chen, Peng

AU - Tang, Lijiang

AU - Jiang, Wenbing

AU - Chen, Xiaomin

AU - He, Wenming

AU - Ahn, Sung Gyun

AU - Yoon, Myeong Ho

AU - Kim, Ung

AU - Lee, Joo Myung

AU - Ki, You Jeong

AU - Shin, Eun Seok

AU - Kim, Chee Hae

AU - Xiang, Jianping

AU - Tahk, Seung Jea

AU - Koo, Bon Kwon

AU - Wang, Jian'an

AU - Jiang, Jun

PY - 2025/1/27

Y1 - 2025/1/27

N2 - Background: The association between coronary microcirculation and clinical outcomes in patients with intermediate stenosis remains unclear. Objectives: The aim of this study was to assess the prognostic significance of angiography-derived index of microcirculatory resistance (angio-IMR) in patients with intermediate coronary stenosis. Methods: This post hoc analysis included 1,658 patients from the FLAVOUR (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients with Intermediate Stenosis) trial, with angio-IMR measured in each vessel exhibiting intermediate stenosis. The primary endpoint was a patient-oriented composite outcome (POCO), a composite of all-cause death, myocardial infarction, or revascularization over a 2-year period. Results: The median follow-up period was 24.8 months (Q1-Q3: 24.4-26.4 months). Over the 2-year follow-up period, patients with angio-IMR >25 exhibited a significantly higher POCO rate in both the percutaneous coronary intervention (PCI) group (35.06% [27 of 77] vs 7.2% [51 of 708]; P < 0.001) and the non-PCI group (17.95% [21 of 117] vs 4.23% [32 of 756]; P < 0.001). After adjusting for potentially related risk factors, angio-IMR >25 remained an independent predictor of the POCO in the PCI group (HR: 6.235; 95% CI: 3.811-10.203; P < 0.001) and the non-PCI group (HR: 5.282; 95% CI: 2.948-9.462; P < 0.001). The addition of angio-IMR demonstrated incremental prognostic value in both an angiographic risk factor model (C-index 0.710 [95% CI: 0.663-0.756] vs 0.615 [95% CI: 0.563-0.664] [P < 0.001]; net reclassification index 0.268 [95% CI: 0.191-0.362; P < 0.001]; integrated discrimination improvement 0.055 [95% CI: 0.030-0.108; P < 0.001]) and a clinical risk factor model (C-index 0.705 [95% CI: 0.658-0.751] vs 0.594 [95% CI: 0.544-0.644] [P < 0.001]; net reclassification index 0.268 [95% CI: 0.171-0.350; P < 0.001]; integrated discrimination improvement 0.057 [95% CI: 0.027-0.102; P < 0.001]). Conclusions: In individuals with intermediate coronary stenosis, elevated angio-IMR is linked to an adverse prognosis. Using angio-IMR significantly enhanced the capability to reclassify patients and accurately estimate the risk for the POCO.

AB - Background: The association between coronary microcirculation and clinical outcomes in patients with intermediate stenosis remains unclear. Objectives: The aim of this study was to assess the prognostic significance of angiography-derived index of microcirculatory resistance (angio-IMR) in patients with intermediate coronary stenosis. Methods: This post hoc analysis included 1,658 patients from the FLAVOUR (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients with Intermediate Stenosis) trial, with angio-IMR measured in each vessel exhibiting intermediate stenosis. The primary endpoint was a patient-oriented composite outcome (POCO), a composite of all-cause death, myocardial infarction, or revascularization over a 2-year period. Results: The median follow-up period was 24.8 months (Q1-Q3: 24.4-26.4 months). Over the 2-year follow-up period, patients with angio-IMR >25 exhibited a significantly higher POCO rate in both the percutaneous coronary intervention (PCI) group (35.06% [27 of 77] vs 7.2% [51 of 708]; P < 0.001) and the non-PCI group (17.95% [21 of 117] vs 4.23% [32 of 756]; P < 0.001). After adjusting for potentially related risk factors, angio-IMR >25 remained an independent predictor of the POCO in the PCI group (HR: 6.235; 95% CI: 3.811-10.203; P < 0.001) and the non-PCI group (HR: 5.282; 95% CI: 2.948-9.462; P < 0.001). The addition of angio-IMR demonstrated incremental prognostic value in both an angiographic risk factor model (C-index 0.710 [95% CI: 0.663-0.756] vs 0.615 [95% CI: 0.563-0.664] [P < 0.001]; net reclassification index 0.268 [95% CI: 0.191-0.362; P < 0.001]; integrated discrimination improvement 0.055 [95% CI: 0.030-0.108; P < 0.001]) and a clinical risk factor model (C-index 0.705 [95% CI: 0.658-0.751] vs 0.594 [95% CI: 0.544-0.644] [P < 0.001]; net reclassification index 0.268 [95% CI: 0.171-0.350; P < 0.001]; integrated discrimination improvement 0.057 [95% CI: 0.027-0.102; P < 0.001]). Conclusions: In individuals with intermediate coronary stenosis, elevated angio-IMR is linked to an adverse prognosis. Using angio-IMR significantly enhanced the capability to reclassify patients and accurately estimate the risk for the POCO.

KW - coronary angiography

KW - index of microcirculatory resistance

KW - intermediate coronary stenosis

KW - microcirculation

KW - prognosis

UR - http://www.scopus.com/inward/record.url?scp=85215253382&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2024.10.017

DO - 10.1016/j.jcin.2024.10.017

M3 - Article

C2 - 39880572

AN - SCOPUS:85215253382

SN - 1936-8798

VL - 18

SP - 171

EP - 183

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 2

ER -

Prognostic Value of Coronary Angiography-Derived Index of Microcirculatory Resistance in Patients With Intermediate Coronary Stenosis

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