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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1489403

Prognostic impact of coronary microvascular dysfunction assessed by AMR in acute coronary syndrome patients with chronic kidney disease

Provisionally accepted
Ziyu Guo Ziyu Guo 1Yike Li Yike Li 2Chen Qiang Chen Qiang 3Jingang Zheng Jingang Zheng 4*
  • 1 Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
  • 2 China-Japan Friendship Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  • 3 Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  • 4 Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine; Department of Cardiology, China-Japan Friendship Hospital, Beijing, China

The final, formatted version of the article will be published soon.

    Angiography-derived microcirculatory resistance (AMR) is proposed as a novel, pressuretemperature-wire-free and less-invasive method to evaluate coronary microvascular dysfunction (CMD). This study aims to examine the prognostic role of CMD assessed by AMR in predicting adverse events in acute coronary syndrome (ACS) patients with chronic kidney disease (CKD).This retrospective cohort study included ACS with CKD patients in the China-Japan Friendship Hospital from January 2016 to November 2022. The patients were divided into CMD and non-CMD groups based on AMR values of less than or greater than 250 mmHg*s/m.A total of 345 eligible patients were included in this study. During a median follow-up of 23.0 months, higher prevalence rate of MACEs (28.3% vs. 15.1%, p = 0.003) and death (20.2% vs.4.1%, P = 0.001) were observed in the CMD group. In multivariate Cox regression analysis, patients in the group of CMD had a 1.843 times higher hazard ratio (HR) for developing MACEs (HR: 1.843, 95% CI: 1.071-3.174, P = 0.027) and 5.325 times higher HR for developing death (HR: 5.325, 95% CI: 1.979-14.327, P < 0.001) for every 10 mmHg*s/m increment in AMR. The incorporation of AMR improved the predictive accuracy of the GRACE score for MACEs and death.This study indicates that the AMR is significantly related to poor prognosis among patients with 3 ACS and CKD. Furthermore, AMR could improve the predictive power of the GRACE risk score. These results indicated that AMR may serve as a valuable clinical tool for classification, risk stratification or therapy individualization in these patients.

    Keywords: Coronary microvascular dysfunction, angiography-derived microvascular resistance (AMR), Acute Coronary Syndrome, Chronic Kidney Disease, MACEs, All-cause mortality

    Received: 01 Sep 2024; Accepted: 13 Dec 2024.

    Copyright: © 2024 Guo, Li, Qiang and Zheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Jingang Zheng, Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine; Department of Cardiology, China-Japan Friendship Hospital, Beijing, China

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