ArticleEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology2025
Single-view angiographic microcirculatory resistance index after primary PCI: the EARLY-MYO-AMR study.
Article in EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- VERMONT non-optimised: Feasibility of angiography-derived vFFR using baseline diagnostic catheter images.International journal of cardiology. Heart & vasculature · 2026Article
- Prognostic value of point-of-care testing for cardiac myosin-binding protein C in early risk assessment of acute myocardial infarction: a prospective cohort study.Scientific reports · 2026Article
- Angiography-Derived Physiology for Coronary Artery Disease Assessment: Expert Opinion From a SCAI Roundtable.Journal of the Society for Cardiovascular Angiography & Interventions · 2026Review
- Coronary slow flow phenomenon: a meta-analysis of clinical risk predictors.Frontiers in cardiovascular medicine · 2026Review
- Ultrasonic flow ratio versus Murray law-based quantitative flow ratio for predicting target vessel failure after IVUS-guided PCI.Frontiers in cardiovascular medicine · 2026Article
- Association of the TyG index and inflammatory burden index with AMR-defined coronary microvascular dysfunction and 12-month MACE after STEMI.Frontiers in endocrinology · 2026Article
- Coronary angiography-derived microcirculatory resistance predicts adverse cardiovascular events in elderly with unstable angina post-percutaneous coronary intervention.Frontiers in aging · 2026Article
- Intracoronary nicorandil improves coronary microcirculatory function after primary PCI in first-episode STEMI: an angiography-derived evaluation using AMR and QFR.Frontiers in cardiovascular medicine · 2026Article
- Angiographic-based assessment of microvascular dysfunction: quo vadis?EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025Article
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23 authors.
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Abstract
backgroundCoronary microvascular dysfunction (CMD) leads to inadequate myocardial perfusion in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). The index of microcirculatory resistance (IMR) is an intraoperative diagnostic tool for CMD. However, its widespread application is hindered by the requirement for pressure wires and hyperaemic agents. The angiographic microcirculatory resistance (AMR) index is concise, convenient, accurate, and serves as a pressure wire-free alternative to the IMR.
aimsThis study aimed to demonstrate the ability of AMR to detect CMD in patients with STEMI undergoing PPCI therapy and to assess its predictive value for long-term prognosis.
methodsThe EARLY-MYO-AMR trial comprised two cohorts. The derivation cohort included 495 patients with STEMI who underwent PPCI within 12 h and cardiac magnetic resonance (CMR) within 14 days of symptom onset. The optimal AMR cutoff value for diagnosing CMD using CMR was determined by analysing the receiver operating characteristic curves. The validation cohort enrolled 2,663 patients with STEMI who underwent PPCI within 12 h of symptom onset from January 2012 to April 2022 across 5 medical centres. All patients were followed up for at least 1 year. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE), including cardiac death, hospitalisation for heart failure, repeat myocardial infarction, and target lesion revascularisation.
resultsThe derivation cohort identified an AMR cutoff >26.6 mmHg*s/dm for predicting CMD post-PPCI (area under the curve 0.721, 95% confidence interval [CI]: 0.677-0.763). Multivariable logistic regression analysis indicated that AMR >26.6 mmHg*s/dm was a CMD risk factor (odds ratio 4.10, 95% CI: 2.56-6.56; p<0.001). The MACE incidence was significantly higher among patients in the validation cohort with AMR >26.6 mmHg*s/dm than among those with AMR ≤26.6 mmHg*s/dm (30.9% vs 21.5%, adjusted hazard ratio [HR] 1.47, 95% CI: 1.20-1.80; p<0.001). MACE incidence increased with AMR, with an adjusted HR of 1.30 (95% CI: 1.17-1.46; p<0.001) per 10 mmHg*s/dm increase. The Bland-Altman and Kappa analyses showed good intra- and interobserver agreement for AMR (intraobserver: bias=-0.104, k=0.914; interobserver: bias=-0.032, k=0.958).
conclusionsAMR >26.6 mmHg*s/dm predicts CMD during PPCI and increased MACE incidence in patients with STEMI. This convenient tool helps in risk stratification and treatment guidance for STEMI prognosis.
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