Key result
LAD culprit in STEMI linked to ~13.9-fold higher risk of suboptimal 9-month post-PCI FFR.
Why the study?
Angiographically successful primary PCI in STEMI does not guarantee normalization of coronary physiology, and residual ischemia may persist. This study evaluated the prevalence and determinants of suboptimal functional revascularization, defined by post-PCI FFR <=0.89, in STEMI patients treated with primary PCI.
What are the prevalence and determinants of suboptimal functional revascularization (post-PCI FFR ≤0.89) at 9 months in STEMI patients treated with primary PCI?
Cohort (n=126)
What are the prevalence and determinants of suboptimal functional revascularization (post-PCI FFR ≤0.89) at 9 months in STEMI patients treated with primary PCI?
Nearly half (44%) of STEMI patients exhibit suboptimal functional revascularization (FFR ≤0.89) at 9 months post-primary PCI, driven primarily by age, LAD culprit territory, and smaller stent diameter rather than procedural factors.
Answers are grounded in this paper and cite their sources.
Suboptimal post-PCI FFR is common and predictable in STEMI; does not yet support routine surveillance but extends risk-stratification research in high-risk subgroups.
Background Primary percutaneous coronary intervention (PCI) is the standard treatment for ST-segment elevation myocardial infarction (STEMI). However, angiographic success PCI does not necessarily reflect normalization of coronary physiology, and residual ischemia may persist. Post-PCI fractional flow reserve (FFR) is well-established method for evaluating suboptimal revascularization. We aimed to evaluate impaired culprit lesion revascularization in patients treated with primary PCI. Purpose To evaluate the prevalence and determinants of suboptimal functional revascularization, defined by post-PCI FFR ≤0.89, in STEMI patients treated with primary PCI. Method In this prospective cohort study, STEMI patients underwent planned follow-up coronary angiography approximately 9 months after index PCI to evaluate residual epicardial disease, when acute microvascular dysfunction is expected to have resolved. Invasive physiological assessment included resting full-cycle ratio (RFR), FFR, and hyperaemic pressure pullback recordings with calculation of the pressure pullback gradient (PPG). Suboptimal functional revascularization was defined as post-PCI FFR ≤0.89. Results Of 126 enrolled patients, post-PCI FFR was available in 122. At follow-up, 54 (44%) patients demonstrated suboptimal FFR (≤0.89). In adjusted analyses, increasing age (odds ratio (OR) 1.06 per year increase, 95% CI 1.02–1.11, p=0.009); anterior infarction (OR 11.96, 95% CI 4.84–32.73, p<0.001) and left anterior descending (LAD) as the culprit vessel (OR 13.92, 95% CI 5.50–39.65, p<0.001) were independently associated with higher risk of suboptimal FFR. Higher admission LVEF (OR 0.96 per % increase, 95% CI 0.92–1.00, p=0.038) and larger stent diameter (OR 0.18 per mm increase, 95% CI 0.06–0.46, p<0.001) were associated with lower risk of suboptimal FFR (Figure 1). Traditional cardiovascular risk factors, lesion complexity, intravascular ultrasound use and time from symptom onset to wire were not associated with post-PCI physiological impairment. Conclusion Nearly half of STEMI patients demonstrate incomplete functional revascularization at follow-up despite apparently successful PCI. Suboptimal FFR appears to be mainly related to age, infarct-related territory (LAD) and luminal dimensions (stent diameter), rather than procedural factors.
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Ozbek et al. (2026) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=126). Left anterior descending (LAD) culprit vessel, anterior infarction, and age vs. Non-LAD culprit vessel, non-anterior infarction, higher LVEF, and larger stent diameter was evaluated on Suboptimal functional revascularization defined as post-PCI FFR <=0.89 (OR 13.92, 95% CI 5.50-39.65, p=<0.001). Primary PCI in STEMI resulted in suboptimal FFR (<=0.89) in 44% of patients at 9 months, driven by LAD culprit vessel (OR 13.92, 95% CI 5.50-39.65) and larger stent diameter (OR 0.18/mm).
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