急性心肌梗死患者非罪犯血管的全面生理评估：这是一项必要措施吗？
Thorough Physiological Assessment in Non-Culprit Vessels of Patients with Acute Myocardial Infarction: Is It a Required Action?
作者信息
Chen Zining, Zhang Yuxuan, Fang Jiacheng, Zheng Yiyue, Chen Delong, Yidilisi Abuduwufuer, Zhang Xinyi, Liu Chi, Huang Jiniu, Ji Rui, Chen Jiamu, Chen Guohui, Lin Ping, Hu Yumeng, Xiang Jianping, Wang Jian'an, Jiang Jun
机构信息
Department of Cardiology of The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China.
出版信息
Cardiovasc Drugs Ther. 2025 Sep 6. doi: 10.1007/s10557-025-07768-0.
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.
背景
急性心肌梗死（AMI）患者中非罪犯血管（NCV）的管理仍是一个未解决的问题。最近开发的基于血管造影的生理评估可能有助于解决这一问题。我们的研究旨在测量AMI患者NCV中的基于血管造影的血流储备分数（Angio-FFR）和基于血管造影的微循环阻力指数（Angio-IMR），并探讨它们的预后价值和必要性。
方法
这项回顾性队列研究纳入了患有多支血管病变（MVD）的AMI患者，并对其进行了为期2年的常规随访。在视觉狭窄率为40%-80%的NCV中测量Angio-FFR和Angio-IMR。主要终点定义为血管导向复合终点（VOCE），包括心源性死亡、靶血管心肌梗死和缺血驱动的靶血管血运重建。
结果
共回顾性纳入503例患者和712条NCV。Angio-FFR≤0.8的NCV发生VOCE的风险显著更高（27%对12.6%，P<0.001），相反，以25为界划分的Angio-IMR组无显著差异（15.15%对11.04%，P=0.383）。多变量Cox回归确定Angio-FFR是VOCE的独立预测因子（HR：1.70，95%CI：1.01-2.84，P<0.05），而Angio-IMR不是（HR：0.88，95%CI：0.43-1.79，P>0.05）。这种相关性在亚组分析和倾向评分匹配中是一致的。
结论
AMI患者NCV的预后与Angio-FFR相关，而与Angio-IMR无关，这表明主要导致额外不良预后的是心外膜血管闭塞而非微循环功能障碍。与Angio-FFR相比，测量Angio-IMR在AMI患者NCV的管理中必要性和临床价值可能有限。
试验注册
网址：https://www.
临床试验
gov。唯一标识符：NCT05696379。研究注册日期：2022年12月13日。
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