Association between coronary angiography-derived index of microcirculatory resistance and ischemic stroke in patients with ST-segment elevation myocardial infarction.
7 affiliations
- 1Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.
- 2Department of Rehabilitation, Children's Hospital of Nanjing Medical University, Nanjing, China.
- 3Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.
- 4Department of Pulmonary and Critical Care Medicine, XuZhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou, 221000, China. [email protected].
- 5Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China. [email protected].
- 6Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China. [email protected].
- 7Department of Neurosurgery, The Affiliated Hospital of Yangzhou University, Yangzhou, 225000, China. [email protected].
Abstract
Background
Stroke is a devastating complication following ST-segment elevation myocardial infarction (STEMI). Coronary microcirculatory dysfunction (CMD) is implicated in adverse post-STEMI outcomes, but its relationship with subsequent stroke is unknown. We aimed to investigate the association of the coronary angiography-derived index of microcirculatory resistance (caIMR), a novel non-invasive tool for assessing CMD, for new-onset ischemic stroke in STEMI patients undergoing primary percutaneous coronary intervention (pPCI).Methods
This single-center, retrospective cohort study enrolled 602 consecutive STEMI patients who underwent successful pPCI between July 2020 and February 2025. The caIMR was calculated post-procedure using specialized software. The primary endpoint was new-onset ischemic stroke. Multivariable Cox proportional hazards regression and restricted cubic spline analyses were used to assess the association between caIMR and stroke risk.Results
Over a median follow-up of 29.3 months, 38 patients (6.3%) developed a new-onset ischemic stroke. In the multivariable Cox model, caIMR was independently associated with the risk of ischemic stroke (HR: 1.044, 95% CI: 1.022-1.065, P < 0.001), along with new-onset atrial fibrillation (HR: 9.113, 95% CI: 4.587-18.107, P < 0.001). A linear dose-response relationship was observed between caIMR levels and the risk of stroke (P for non-linearity = 0.975). Reclassification analysis showed that adding caIMR improved risk classification, with an IDI of 0.0307 (95% CI: 0.0031-0.0636; P = 0.030) and an NRI of 0.3887 (95% CI: 0.3156-0.4618; P < 0.001).Conclusion
Elevated caIMR is independently associated with an increased risk of long-term ischemic stroke in STEMI patients after pPCI. This easily accessible metric may serve as a valuable tool for future risk stratification in this patient population.
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BibTeX
@article{cui2026association,
title = {{Association between coronary angiography-derived index of microcirculatory resistance and ischemic stroke in patients with ST-segment elevation myocardial infarction.}},
author = {Chenchen Cui and Zijia Sun and Mingchang Du and Peng Lu and Yuan Lu and He Zhang and Qihua Xiao and Fan Yang},
journal = {BMC cardiovascular disorders},
year = {2026},
month = jul,
doi = {10.1186/s12872-026-06348-w},
url = {https://europepmc.org/article/MED/42902127},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Association between coronary angiography-derived index of microcirculatory resistance and ischemic stroke in patients with ST-segment elevation myocardial infarction.
AU - Chenchen Cui
AU - Zijia Sun
AU - Mingchang Du
AU - Peng Lu
AU - Yuan Lu
AU - He Zhang
AU - Qihua Xiao
AU - Fan Yang
PY - 2026
DA - 2026/07/01
JO - BMC cardiovascular disorders
DO - 10.1186/s12872-026-06348-w
UR - https://europepmc.org/article/MED/42902127
AB - Background Stroke is a devastating complication following ST-segment elevation myocardial infarction (STEMI). Coronary microcirculatory dysfunction (CMD) is implicated in adverse post-STEMI outcomes, but its relationship with subsequent stroke is unknown. We aimed to investigate the association of the coronary angiography-derived index of microcirculatory resistance (caIMR), a novel non-invasive tool for assessing CMD, for new-onset ischemic stroke in STEMI patients undergoing primary percutaneous coronary intervention (pPCI).Methods This single-center, retrospective cohort study enrolled 602 consecutive STEMI patients who underwent successful pPCI between July 2020 and February 2025. The caIMR was calculated post-procedure using specialized software. The primary endpoint was new-onset ischemic stroke. Multivariable Cox proportional hazards regression and restricted cubic spline analyses were used to assess the association between caIMR and stroke risk.Results Over a median follow-up of 29.3 months, 38 patients (6.3%) developed a new-onset ischemic stroke. In the multivariable Cox model, caIMR was independently associated with the risk of ischemic stroke (HR: 1.044, 95% CI: 1.022-1.065, P < 0.001), along with new-onset atrial fibrillation (HR: 9.113, 95% CI: 4.587-18.107, P < 0.001). A linear dose-response relationship was observed between caIMR levels and the risk of stroke (P for non-linearity = 0.975). Reclassification analysis showed that adding caIMR improved risk classification, with an IDI of 0.0307 (95% CI: 0.0031-0.0636; P = 0.030) and an NRI of 0.3887 (95% CI: 0.3156-0.4618; P < 0.001).Conclusion Elevated caIMR is independently associated with an increased risk of long-term ischemic stroke in STEMI patients after pPCI. This easily accessible metric may serve as a valuable tool for future risk stratification in this patient population.
SN - 1471-2261
ER -