Application of AMR in evaluating microvascular dysfunction after ST-segment elevation myocardial infarction

Abstract

AbstractBACKGROUNDQuantitative flow ratio (QFR) is a new method to estimate fractional flow reserve based on three-dimensional quantitative coronary angiography, from which angiography-derived microcirculatory resistance (AMR) without guidewires and adenosine is derived as an indicator of microvascular dysfunction. This study aimed to assess coronary microvascular dysfunction (CMD) in patients with ST-segment elevation myocardial infarction (STEMI) by AMR.METHODSA retrospective collection of 506 STEMI patients who successfully underwent percutaneous coronary intervention (PCI) from June 1, 2020, to September 28, 2021, was divided into the CMD group and the non-CMD group based on the value of AMR, while we used propensity score matching (PSM) to adjust for baseline characteristics. The primary endpoint was the 1-year rate of major adverse cardiac events (MACE), a composite of death from any cause, myocardial infarction, readmission for heart failure, or ischemia-driven revascularization.RESULTSThe 1-year rate of MACE in CMD group was higher than that in the non-CMD group (post-match HR 1.954, 95% CI:1.025 to 3.726; 14.1% vs. 7.3%, P=0.042); Subgroup analysis showed that the readmission rate of heart failure (HF) was higher in the CMD group than in the non-CMD group (post-match HR 5.082, 95% CI:1.471 to 17.554; 7.9% vs. 1.6%. P=0.010). The results of survival analysis suggested that AMR ≥250mmHg*s/m was an independent predictor of the primary endpoint in STEMI patients (post-match adjusted HR 2.265, 95% CI: 1.136 to 4.515, P = 0.020). CONCLUSION: As an indicator of microvascular dysfunction, AMR can be a viable alternative to invasive wire-based IMR in STEMI patients.