Cardiovascular drugs and therapy · 2025
Thorough Physiological Assessment in Non-Culprit Vessels of Patients with Acute Myocardial Infarction: Is It a Required Action?
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Chen Zining, Zhang Yuxuan, Fang Jiacheng, Zheng Yiyue, Chen Delong, Yidilisi Abuduwufuer, Zhang Xinyi, Liu Chi, Huang Jiniu, Ji Rui, Chen Jiamu, Chen Guohui, Lin Ping, Hu Yumeng, Xiang Jianping, Wang Jian'an, Jiang Jun
Аннотация
BACKGROUNDS: The management of non-culprit vessels (NCV) among individuals with acute myocardial infarction (AMI) remains an unsolved problem. Angiography-derived physiological assessments developed recently may help address this issue. Our study aims to measure angiography-derived fractional flow reserve (Angio-FFR) and angiography-derived index of microcirculatory resistance (Angio-IMR) in NCVs of AMI patients and explore their prognostic values and necessity.
METHODS: This retrospective cohort study enrolled AMI patients with multivessel disease (MVD) who were routinely followed up for 2 years. Angio-FFR and Angio-IMR were measured in NCVs with 40%-80% visual stenosis. The primary endpoint was defined as the vessel-oriented composite endpoint (VOCE), comprising cardiac death, target vessel myocardial infarction, and ischemia-driven target vessel revascularization.
RESULTS: A total of 503 patients and 712 NCVs were retrospectively included. NCVs with Angio-FFR ≤ 0.8 had significantly higher hazards of VOCE (27% vs. 12.6%, P < 0.001), contrarily, Angio-IMR groups divided by 25 exhibited no significant discrepancy (15.15% vs. 11.04%, P = 0.383). Multivariate Cox regression identified Angio-FFR as an independent predictor of VOCE (HR: 1.70, 95% CI: 1.01-2.84, P < 0.05), whereas Angio-IMR did not (HR: 0.88, 95% CI: 0.43-1.79, P > 0.05). Such correlation was consistent in subgroup analysis and propensity score matching.
CONCLUSIONS: The prognosis of NCVs in AMI patients correlated with Angio-FFR but not with Angio-IMR, indicating it is epicardial vessel occlusion rather than microcirculatory dysfunction, predominantly leading to additional adverse prognosis. Compared to Angio-FFR, measuring Angio-IMR could be of limited necessity and clinical value in the management of NCVs among AMI patients.
TRIAL REGISTRATION: URL: https://www.
CLINICALTRIALS: gov . Unique identifier: NCT05696379. Study Registration Dates: 2022-12-13.
METHODS: This retrospective cohort study enrolled AMI patients with multivessel disease (MVD) who were routinely followed up for 2 years. Angio-FFR and Angio-IMR were measured in NCVs with 40%-80% visual stenosis. The primary endpoint was defined as the vessel-oriented composite endpoint (VOCE), comprising cardiac death, target vessel myocardial infarction, and ischemia-driven target vessel revascularization.
RESULTS: A total of 503 patients and 712 NCVs were retrospectively included. NCVs with Angio-FFR ≤ 0.8 had significantly higher hazards of VOCE (27% vs. 12.6%, P < 0.001), contrarily, Angio-IMR groups divided by 25 exhibited no significant discrepancy (15.15% vs. 11.04%, P = 0.383). Multivariate Cox regression identified Angio-FFR as an independent predictor of VOCE (HR: 1.70, 95% CI: 1.01-2.84, P < 0.05), whereas Angio-IMR did not (HR: 0.88, 95% CI: 0.43-1.79, P > 0.05). Such correlation was consistent in subgroup analysis and propensity score matching.
CONCLUSIONS: The prognosis of NCVs in AMI patients correlated with Angio-FFR but not with Angio-IMR, indicating it is epicardial vessel occlusion rather than microcirculatory dysfunction, predominantly leading to additional adverse prognosis. Compared to Angio-FFR, measuring Angio-IMR could be of limited necessity and clinical value in the management of NCVs among AMI patients.
TRIAL REGISTRATION: URL: https://www.
CLINICALTRIALS: gov . Unique identifier: NCT05696379. Study Registration Dates: 2022-12-13.