ArticleBMC cardiovascular disorders2026
Association between coronary angiography-derived index of microcirculatory resistance and ischemic stroke in patients with ST-segment elevation myocardial infarction.
Article in BMC cardiovascular disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundStroke 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).
methodsThis 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.
resultsOver 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).
conclusionElevated 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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