Key result
High radial wall strain in non-culprit lesions linked to ~7.5-fold higher risk of unplanned revascularization.
Why the study?
Deferred non-culprit vessels with mild-to-intermediate stenosis in AMI patients remain at heightened risk of progression and subsequent revascularization. The prognostic utility of angiography-derived coronary radial wall strain in these untreated mild-to-intermediate lesions warranted investigation.
Does angiography-derived maximal radial wall strain (RWSmax >= 13.0%) predict unplanned target lesion revascularization in untreated mild-to-intermediate non-culprit lesions among patients with acute myocardial infarction?
Case-Control (n=284)
Does angiography-derived maximal radial wall strain (RWSmax >= 13.0%) predict unplanned target lesion revascularization in untreated mild-to-intermediate non-culprit lesions among patients with acute myocardial infarction?
In AMI patients undergoing primary PCI, an angiography-derived maximal radial wall strain >= 13.0% in deferred mild-to-intermediate non-culprit lesions strongly predicts future unplanned target lesion revascularization.
RWSmax ≥13% was associated with higher revascularization risk in deferred lesions; hypothesis-generating for prospective validation in post-AMI patients.
Background Despite mild-to-intermediate stenosis, deferred non-culprit vessels in patients with acute myocardial infarction (AMI) remain at heightened risk of progression and subsequent revascularization. Angiography-derived coronary radial wall strain (RWS) is a novel approach for identifying vulnerable coronary plaque prone to future adverse events. This study aimed to investigate the prognostic utility of RWS in untreated mild-to-intermediate lesions in AMI patients. Methods Consecutive AMI patients who underwent primary percutaneous coronary intervention (PCI) from January 2009 to December 2018 had at least 1 coronary lesion with a percent diameter stenosis (DS%) of 30% to 70% in deferred non-culprit vessels were screened for enrollment. Patients were followed up until the occurrence of unplanned target lesion revascularization or the end of the study period (January 31, 2024). Patients were divided into two groups according to unplanned revascularization occurrence. A 1:3 propensity score matching was implemented. Results All together, 71 lesions with revascularization and 213 matched controls were enrolled. Baseline characteristics were generally well-balanced between the two groups. Maximal RWS (RWSmax) was significantly higher in the revascularization group compared to the control group [14.1 (12.3-15.5)% vs. 11.3 (10.1-13.35)%, P < 0.001]. The area under the curve (AUC) for RWSmax to predict unplanned revascularization was 0.746 (95% CI: 0.685-0.807, p < 0.001). Patients with at least one non-culprit lesion being RWSmax ≥ 13.0% had a significantly higher risk of unplanned revascularization compared to those without (risk ratio 7.463, 95% CI: 4.082-13.699, P < 0.001). Conclusion Among patients with AMI, a high RWSmax of ≥ 13.0% in mild-to-intermediate lesions in non-culprit vessels was significantly associated with an increased risk of subsequent revascularization.FlowchartHigh RWSmax predicts more revascularization.
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Lu et al. (2026) conducted a case-control in Acute myocardial infarction with mild-to-intermediate non-culprit coronary lesions (n=284). Maximal radial wall strain (RWSmax) >= 13.0% vs. Maximal radial wall strain (RWSmax) < 13.0% was evaluated on Unplanned target lesion revascularization (RR 7.463, 95% CI 4.082-13.699, p=<0.001). Maximal radial wall strain ≥13.0% in mild-to-intermediate non-culprit lesions after AMI predicted unplanned revascularization (RR 7.463; 95% CI 4.082-13.699; P<0.001).
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