The Prognostic Impact of Diabetes Status and Postoperative Murray law‐based Quantitative Flow Ratio Value in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Abstract

Abstract Introduction: Patients with diabetes mellitus (DM) and acute myocardial infarction (AMI) have a higher incidence of microcirculatory disturbance, which may affect the accuracy of Murray law-based quantitative flow ratio (µQFR) values. Whether diabetic status affects the relationship between postoperative µQFR values and prognosis in patients with AMI remains unclear. Methods This was a retrospective analysis. Patients with AMI who underwent percutaneous coronary intervention (PCI) were included and divided into two groups based on the cut-off value for post-PCI µQFR. The primary endpoint was vessel-oriented composite events (VOCE), defined as the composite of vessel-related cardiovascular death, vessel-related MI, and target vessel revascularization (TVR). Results A total of 649 patients with AMI and 937 coronary arteries were included. The optimal µQFR cut-off value was 0.89. Compared to lower postoperative µQFR values (µQFR < 0.89), higher postoperative µQFR values (µQFR ≥ 0.89) were associated with reduced VOCE incidence (HR = 0.54; 95%CI: 0.37–0.78, P < 0.001), regardless of diabetic status (HR = 0.54; 95% CI: 0.31–0.92, P = 0.023 in DM; HR = 0.56; 95%CI: 0.33–0.93, P = 0.026 in non-DM; interaction P value = 0.936). Additionally, higher postoperative QFR values (µQFR ≥ 0.89) were associated with significantly lower rates of cardiac death and TVR, but not MI, compared to lower postoperative µQFR values (µQFR < 0.89). These findings were consistent in diabetic and nondiabetic patients. Conclusion Regardless of diabetes status, postoperative µQFR measurement was related to VOCE incidence in AMI, with lower postoperative µQFR values indicating a poorer prognosis.