Thorough Physiological Assessment in Non-Culprit Vessels of Patients with Acute Myocardial Infarction: Is It a
Zining Chen1,2,3,4, Yuxuan Zhang1,2,3,4, Jiacheng Fang1,2,3,4
1Department of Cardiology of The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
Insights
Angiography-derived fractional flow reserve (Angio-FFR) predicts outcomes in non-culprit vessels of acute myocardial infarction (AMI) patients, while Angio-IMR does not. This suggests epicardial occlusion, not microcirculatory issues, drives prognosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Physiology
Background:
- Management of non-culprit vessels (NCVs) in acute myocardial infarction (AMI) is challenging.
- Recent angiography-derived physiological assessments may aid NCV management.
- Prognostic value of these assessments in NCVs requires clarification.
Purpose of the Study:
- To measure angiography-derived fractional flow reserve (Angio-FFR) and angiography-derived index of microcirculatory resistance (Angio-IMR) in NCVs of AMI patients.
- To explore the prognostic values of Angio-FFR and Angio-IMR in NCVs.
- To determine the necessity of measuring Angio-IMR compared to Angio-FFR in NCVs.
Main Methods:
- Retrospective cohort study of 503 AMI patients with multivessel disease (MVD).
- Angio-FFR and Angio-IMR measured in NCVs with 40%-80% visual stenosis.
- Primary endpoint: vessel-oriented composite endpoint (VOCE) over 2-year follow-up.
Main Results:
- NCVs with Angio-FFR ≤ 0.8 showed significantly higher VOCE rates (27% vs. 12.6%, P < 0.001).
- Angio-IMR did not show significant differences in VOCE based on thresholds (15.15% vs. 11.04%, P = 0.383).
- Angio-FFR was an independent predictor of VOCE (HR: 1.70), while Angio-IMR was not (HR: 0.88).
Conclusions:
- Prognosis of NCVs in AMI patients correlates with Angio-FFR, not Angio-IMR.
- Epicardial vessel occlusion, rather than microcirculatory dysfunction, appears to drive adverse prognosis in NCVs.
- Measuring Angio-IMR has limited necessity and clinical value for NCV management in AMI compared to Angio-FFR.
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.
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