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Predictive Value of Combining Angio-Based Index of Microcirculatory Resistance and Fractional Flow Reserve in
Jinglin Li1, Pengxin Xie1, Yumeng Hu2
1Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China.
Insights
Assessing coronary function and microcirculation using angio-based fraction flow reserve (AccuFFR) and index of microcirculatory resistance (AccuIMR) after percutaneous coronary intervention (PCI) helps predict long-term prognosis in ST-segment elevation myocardial infarction (STEMI) patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- Limited research exists on assessing coronary function and microcirculation for long-term prognosis in ST-segment elevation myocardial infarction (STEMI) patients.
- Percutaneous coronary intervention (PCI) is a standard treatment for STEMI, but post-procedural assessment of coronary function and microcirculation requires further investigation.
Purpose of the Study:
- To evaluate the prognostic value of angio-based fraction flow reserve (AccuFFR) and index of microcirculatory resistance (AccuIMR) after primary PCI in STEMI patients.
- To determine if these parameters can identify patients at higher risk for major adverse cardiovascular events (MACE).
Main Methods:
- Retrospective analysis of 1297 STEMI patients who underwent PCI.
- AccuFFR and AccuIMR were measured immediately post-PCI.
- Patients were categorized into four groups based on AccuFFR and AccuIMR: normal coronary function, macrovascular disorder, microvascular disorder, and mixed disorder.
Main Results:
- The mixed disorder group exhibited significantly higher risks of MACE, all-cause death, cardiovascular death, and heart failure readmission.
- Both AccuFFR and AccuIMR were identified as independent predictors of MACE.
- A nomogram model incorporating these parameters demonstrated high accuracy in predicting 1, 3, and 5-year MACE.
Conclusions:
- Immediate post-PCI assessment of coronary function and microcirculation is crucial for predicting STEMI patient prognosis.
- AccuFFR and AccuIMR provide valuable insights into long-term outcomes, aiding in risk stratification and management.
Background:
The assessment of coronary function and microcirculation in patients with ST-segment elevation myocardial infarction (STEMI) may be useful to guide long-term prognosis, but the research is limited. This study aimed to investigate the value of angio-based fraction flow reserve (AccuFFR) and an index of microcirculatory resistance (AccuIMR) after percutaneous coronary intervention (PCI) for evaluating the long-term prognosis of STEMI patients.
Methods:
Data of patients with STEMI who underwent PCI at Peking University Third Hospital between January 2017 and March 2022 were retrospectively analyzed. AccuFFR and AccuIMR were analyzed immediately after primary PCI. According to AccuFFR and AccuIMR, patients were classified into 4 groups: normal coronary function, macrovascular disorder, microvascular disorder, and mixed disorder.
Results:
A total of 1297 patients were enrolled. The median follow-up time was 35 (24, 58) months. The risks of major adverse cardiovascular events (MACE), all-cause death, cardiovascular death, and readmission for heart failure in the mixed disorder group were significantly higher than those in the other 3 groups (all P < 0.001). Both AccuFFR (hazard ratio [HR], 0.948 per 0.01 increase; 95% confidence ratio [CI], 0.914-0.983; P = 0.004) and AccuIMR (HR, 1.018; 95% CI, 1.009-1.027; P < 0.001) were independent predictors of MACE. A nomogram model was established to predict MACE after PCI in patients with STEMI at 1, 3, and 5 years. The receiver-operating characteristic (ROC) curve, C-index, and calibration curve showed that the model had high discrimination.
Conclusions:
Coronary function and microcirculation assessment immediately after primary PCI are important in evaluating the prognosis of patients with STEMI.
Trial Registration Number:
NCT06435728.
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