Abstract
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. 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 four groups: normal coronary function, macrovascular disorder, microvascular disorder, and mixed disorder. 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 three groups (all P < 0.001). Both AccuFFR (hazard ratio [HR]: 0.948 per 0.01 increase, 95%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 ROC curve, C-index, and calibration curve showed that the model had high discrimination. Coronary function and microcirculation assessment immediately after primary PCI are important in evaluating the prognosis of patients with STEMI. (Trial registration: NCT06435728).
Published Version
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