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Backgrounds <p>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.</p> Methods <p>This retrospective cohort study enrolled AMI patients with multivessel disease (MVD) who were routinely followed up for 2&#xa0;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.</p> Results <p>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%,<i> P</i> &lt; 0.001), contrarily, Angio-IMR groups divided by 25 exhibited no significant discrepancy (15.15% vs. 11.04%, <i>P</i> = 0.383). Multivariate Cox regression identified Angio-FFR as an independent predictor of VOCE (HR: 1.70, 95% CI: 1.01–2.84, <i>P</i> &lt; 0.05), whereas Angio-IMR did not (HR: 0.88, 95% CI: 0.43–1.79, <i>P</i> &gt; 0.05). Such correlation was consistent in subgroup analysis and propensity score matching.</p> Conclusions <p>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.</p> Trial Registration <p>URL: <a href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</a>.&#xa0;</p> <p>Unique identifier: NCT05696379.&#xa0;</p> <p>Study Registration Dates: 2022–12-13</p> Graphical Abstract <p></p>

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Thorough Physiological Assessment in Non-Culprit Vessels of Patients with Acute Myocardial Infarction: Is It a Required Action?

  • 期刊论文

  • 发表日期：

    2025年9月6日

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  • Zining Chen,
  • Yuxuan Zhang,
  • Jiacheng Fang,
  • Yiyue Zheng,
  • Delong Chen,
  • Abuduwufuer Yidilisi,
  • Xinyi Zhang,
  • Chi Liu,
  • Jiniu Huang,
  • Rui Ji,
  • Jiamu Chen,
  • Guohui Chen,
  • Ping Lin,
  • Yumeng Hu,
  • Jianping Xiang,
  • Jian’an Wang,
  • Jun Jiang

摘要

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

Graphical Abstract