Key result
Lower AccuFFR and higher AccuIMR post-PCI independently predict MACE in STEMI patients.
Why the study?
Assessing coronary function and microcirculation in STEMI patients may guide long-term prognosis, but research on this is limited.
Does the combination of angio-based fractional flow reserve (AccuFFR) and index of microcirculatory resistance (AccuIMR) predict major adverse cardiovascular events in patients with STEMI after primary PCI?
Cohort (n=1,297)
No
Does the combination of angio-based fractional flow reserve (AccuFFR) and index of microcirculatory resistance (AccuIMR) predict major adverse cardiovascular events in patients with STEMI after primary PCI?
Angio-based FFR and IMR measured immediately after primary PCI independently predict long-term MACE in patients with STEMI.
AccuFFR and AccuIMR may aid post-PCI risk stratification in STEMI; leaves open whether they guide therapy or improve outcomes.
BACKGROUND: 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. METHODS: 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 4 groups: normal coronary function, macrovascular disorder, microvascular disorder, and mixed disorder. RESULTS: 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 3 groups (all P < 0.001). Both AccuFFR (hazard ratio [HR], 0.948 per 0.01 increase; 95% confidence ratio [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 receiver-operating characteristic (ROC) curve, C-index, and calibration curve showed that the model had high discrimination. CONCLUSIONS: Coronary function and microcirculation assessment immediately after primary PCI are important in evaluating the prognosis of patients with STEMI. TRIAL REGISTRATION NUMBER: NCT06435728.
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Li et al. (2025) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=1,297). AccuFFR and AccuIMR vs. Normal coronary function, macrovascular disorder, microvascular disorder, and mixed disorder groups was evaluated on Major adverse cardiovascular events (MACE) (HR 0.948 (AccuFFR) / HR 1.018 (AccuIMR), 95% CI 0.914-0.983 / 1.009-1.027, p=0.004 / <0.001). Both AccuFFR (HR 0.948; 95% CI 0.914-0.983) and AccuIMR (HR 1.018; 95% CI 1.009-1.027) measured immediately after primary PCI were independent predictors of MACE in patients with STEMI.
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