What is the clinical evidence from this study?

Study design: Observational. Population: ST-elevation myocardial infarction (STEMI) (n=656). Intervention: AI-assisted quantitative coronary angiography (AI-QCA) vs. Angiography-guided PCI. Primary outcome: Total procedure time (from start of coronary angiography to end of PCI) (Mean difference -4.7, 95% CI -7.5 to -1.9, p=<0.001).

August 28, 2025Journal of Korean Medical Science1 citationsOpen Access

Evaluating the Efficacy of AI-Assisted Quantitative Coronary Angiography in Reducing Procedural Time for Primary PCI in STEMI Patients: A Retrospective Analysis

Q: What are the key findings of this study?

AI-assisted quantitative coronary angiography significantly reduced the total procedure time of primary PCI for STEMI by an average of 4.7 minutes compared to conventional angiography-guided PCI.

Q: What does this research mean for the field?

AI-assisted quantitative coronary angiography significantly reduced the total procedure time of primary PCI for STEMI by an average of 4.7 minutes compared to conventional angiography-guided PCI. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

JAJoon Ho AhnChonnam National University Hospital SPSeongho ParkChonnam National University Hospital SLSeung Hun LeeChonnam National University

Key Result

AI-assisted quantitative coronary angiography significantly reduced the total procedure time of primary PCI for STEMI by an average of 4.7 minutes compared to conventional angiography-guided PCI.

Study Design

Type

Observational (n=656)

Multicenter

Structured PICO

Does AI-assisted quantitative coronary angiography reduce procedure time in patients undergoing primary PCI for STEMI?

Population

656 propensity-matched adults (≥18 years) undergoing emergency primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI), mean age ~65, ~81% male. Exclusions: use of intravascular imaging (OCT or IVUS), door-to-balloon time ≥90 minutes, chronic total occlusion, and cardiogenic shock.

Intervention

AI-assisted quantitative coronary angiography (QCA) using MPXA-2000 software during primary PCI

Comparator

Conventional angiography-guided primary PCI

Outcome

Time from coronary angiography to PCI completion (total procedure time)surrogate

AI-assisted quantitative coronary angiography significantly reduces procedural time during primary PCI for STEMI without increasing contrast use or adverse in-hospital outcomes.

Main Result

Effect estimate: Mean difference -4.7 (95% CI -7.5 to -1.9)

Absolute Event Rate: 34.9% vs 39.5%

p-value: p=<0.001

Limitations

Retrospective, single-center design introduces potential biases and limits generalizability
Operator matching was not feasible given the diverse backgrounds of the interventionalist pool
Study design precluded high-resolution temporal analysis of specific procedural steps impacted by AI-QCA
Long-term outcomes were not assessed, limiting understanding of AI-QCA's impact on patient prognosis

Abstract

Background: Rapid reperfusion is crucial in ST-elevation myocardial infarction (STEMI).We investigated whether AI-assisted quantitative coronary angiography (QCA) can reduce the procedure time for primary percutaneous coronary intervention (PCI) in patients with STEMI.Methods: This single-center, retrospective study compared primary PCI assisted by MPXA, an AI-based QCA software, with angiography-guided PCI in 1,041 patients with STEMI.To minimize potential bias, a 1:3 propensity score matching was performed between the treatment and control groups.The primary endpoint was the time from coronary angiography to PCI completion.The secondary endpoints included total contrast media volume during the procedure, in-hospital mortality, and in-hospital cardiac death.Results: After propensity score matching, 164 and 492 patients in the AI-QCA-assisted and angiography-guided groups, respectively, were analyzed.The AI-QCA-assisted PCI group showed significant reduction in procedure time than the angiography-guided PCI group (34.9 13.9 vs 39.5 17.1 minutes, P < 0.001).There was no significant difference in contrast media volume between the two groups (132.0 42.2 vs 135.8 48.0 mL, P = 0.354).Furthermore, no significant differences were observed in in-hospital mortality (2.4% vs. 3.0%, P = 0.692) or cardiac mortality (2.4% vs. 2.8%, P = 0.786) between the AI-QCA-assisted PCI and control groups.Conclusion: AI-assisted QCA significantly reduced the overall procedure time of primary PCI for STEMI, primarily by streamlining stent sizing and optimization processes without decreasing contrast use.Given that STEMI procedures typically begin with small-diameter balloon inflation to maintain blood flow and minimize complications, the time saved by optimal stent deployment could be clinically beneficial by allowing faster complete reperfusion.Larger studies are needed to confirm the potential clinical benefit of reducing the procedure time using AI-QCA in STEMI treatment.

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