Elevated angiography-derived microvascular resistance and HbA1c levels jointly predict adverse outcomes in patients with diabetic STEMI: a multicenter retrospective cohort study - Report - MDSpire
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Increased Microvascular Resistance from Angiography and HbA1c Levels as Predictors of Poor Outcomes in Diabetic STEMI Patients: A Multicenter Retrospective Analysis

  • By

  • Shiyi Gao

  • Yu Wang

  • Jun Wang

  • Qiang Zeng

  • Zengwei Cheng

  • Zichen Han

  • Hongju Wang

  • Miaonan Li

  • Sigan Hu

  • June 22, 2026

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Increased Microvascular Resistance and HbA1c Levels Predict Poor Outcomes in Diabetic STEMI Patients

Overview

This study identifies elevated angiography-derived microvascular resistance (AMR) and HbA1c levels as significant predictors of major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with type 2 diabetes mellitus (T2DM) and ST-segment elevation myocardial infarction (STEMI).

Background

The mortality rate associated with acute ST-segment elevation myocardial infarction (STEMI) is increasing globally, particularly among patients with type 2 diabetes mellitus (T2DM). These patients are at a heightened risk for adverse clinical outcomes due to coronary microvascular dysfunction. Understanding the prognostic value of microvascular resistance and glycemic control is crucial.

Data Highlights

VariableHazard Ratio (HR)95% Confidence Interval (CI)
HbA1c1.4031.131-1.740
AMR1.2131.105-1.520
NT-proBNP1.2441.1053-2.868
HbA1c ≥6.5% and AMR ≥250.5 mmHg·s/m6.9033.260-14.618

Key Findings

  • Elevated AMR is independently associated with MACCEs in diabetic STEMI patients.
  • HbA1c levels ≥6.5% significantly increase the risk of MACCEs.
  • Nonlinear relationships exist between MACCEs and both HbA1c and AMR levels.
  • Combined evaluation of AMR and HbA1c enhances risk stratification for MACCEs.
  • Coronary microvascular dysfunction is prevalent in T2DM patients with STEMI.

Clinical Implications

Assessing AMR and HbA1c levels can provide insights for risk stratification in diabetic patients post-STEMI.

Conclusion

The study highlights the importance of evaluating microvascular resistance and glycemic control in predicting adverse outcomes in diabetic patients with STEMI.

Related Resources & Content

  1. Clinical Research in Cardiology, 2025 -- Effects of Diabetes on Clinical Outcomes in Patients with ST-Elevation Myocardial Infarction and Multivessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention
  2. Clinical Research in Cardiology, 2025 -- Forecasting MRI-identified microvascular obstruction and its long-term consequences following acute myocardial infarction
  3. Clinical Research in Cardiology, 2023 -- Physiology-Guided Percutaneous Coronary Intervention in Diabetic Patients with Intermediate Coronary Artery Disease
  4. Hub - 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes - Professional Heart Daily | American Heart Association
  5. Frontiers in Cardiovascular Medicine — Effect of stress-induced hyperglycaemia on clinical outcome in paitients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention
  6. Hub - 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes - Professional Heart Daily | American Heart Association
  7. Index of Microcirculatory Resistance to predict microvascular obstruction in STEMI: A systematic review and meta-analysis - PubMed
  8. Frontiers | Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis

Original Source(s)

Elevated angiography-derived microvascular resistance and HbA1c levels jointly predict adverse outcomes in patients with diabetic STEMI: a multicenter retrospective cohort study

  • by Shiyi Gao, Yu Wang, Jun Wang, Qiang Zeng, Zengwei Cheng, Zichen Han, Hongju Wang, Miaonan Li, Sigan Hu

  • June 22, 2026

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