The Value of Optical Coherence Tomography Parameters in Estimating Non-Critical Lesions in Patients with Acute Myocardial Infarction

Background Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Accurate assessment of coronary lesion severity is essential for guiding revascularization. Fractional flow reserve (FFR) is the gold standard for functional evaluation of coronary stenoses, but data on intracoronary hemodynamic assessment in patients with acute myocardial infarction are limited. Optical coherence tomography (OCT) provides high-resolution intravascular imaging and may offer additional insights into lesion severity. Aim To investigate the correlation between OCT-derived measurements and FFR values in patients with acute myocardial infarction. Methods The study included 114 patients with acute myocardial infarction (STEMI or NSTEMI) undergoing primary percutaneous coronary intervention (PCI) of the culprit lesion. Intermediate stenoses in non-culprit vessels (151 lesions) were evaluated during staged procedures with OCT and FFR. Minimal luminal area (MLA) and percent luminal area stenosis (PAS) were analyzed in relation to FFR values. Results OCT-derived parameters showed good correlation with FFR values. In multivariable logistic regression, MLA and PAS were independent predictors of FFR <0.80. The optimal cut-off values were 2.08 mm 2 for MLA and 76.85% for PAS. Conclusions OCT-derived parameters may help identify functionally significant non-culprit lesions in patients with acute myocardial infarction and can complement physiological assessment in clinical practice.