Diabetes Obes Metab. 2026 May 24. doi: 10.1111/dom.70848. Online ahead of print.
ABSTRACT
AIMS: This study aimed to assess the association of coronary microvascular dysfunction (CMD) assessed by the angiography-derived index of microcirculatory resistance (angio-IMR) with long-term cardiovascular outcomes in ST-elevation myocardial infarction (STEMI) patients stratified by obesity categories.
MATERIALS AND METHODS: In this multicentre prospective cohort, STEMI patients undergoing primary percutaneous coronary intervention (PPCI) were enrolled. Patients were stratified by obesity categories (healthy weight: BMI < 24 kg/m2; overweight: 24-28 kg/m2; obesity: ≥ 28 kg/m2). CMD was defined as angio-IMR > 40 U.
RESULTS: Of 497 STEMI patients, CMD prevalence was comparable across BMI groups (p = 0.875). The cumulative incidence of MACCE was significantly higher in the CMD group than in the non-CMD group among patients with obesity (33.3% vs. 15.0%, log-rank p = 0.016), but not among those with overweight (19.6% vs. 15.9%, log-rank p = 0.565) and healthy weight (20.7% vs. 17.4%, log-rank p = 0.673). CMD independently predicted MACCE in obesity (adjusted HR; p = 0.020), with consistent results for continuous angio-IMR (adjusted HR 1.03, p < 0.001). No associations existed in patients with overweight or healthy weight. Additionally, CMD was associated with a higher prevalence of intramyocardial haemorrhage exclusively in obesity (adjusted OR 4.40, p = 0.003) and overweight (adjusted OR 2.65, p = 0.007).
CONCLUSION: CMD assessed by angio-IMR is an independent predictor of MACCE in STEMI patients with obesity, but not those without obesity. Patients with obesity and STEMI who have CMD may represent a high-risk subgroup for future trials of microvascular-protective therapies.
PMID:42178140 | DOI:10.1111/dom.70848