Functional or anatomical assessment of non-culprit lesions in acute myocardial infarction

作者：Xueming Xu, Chao Fang, Senqing Jiang, Yuzhu Chen, Jiawei Zhao, Sibo Sun, Yini Wang, Lulu Li, Dongxu Huang, Shuang Li, Huai Yu, Tao Chen, Jinfeng Tan, Xiaohui Liu, Jihong Dai, Gary S. Mintz, Bo Yu · 发表于：EuroIntervention · 年份：2025 · DOI：10.4244/eij-d-24-00720 · 被引用次数：7 · 研究领域：Coronary Interventions and Diagnostics、Cardiac Imaging and Diagnostics、Acute Myocardial Infarction Research

BACKGROUND: Previous studies have reported the value of quantitative flow ratio (QFR) to assess the physiological significance of non-culprit lesions (NCLs) in acute myocardial infarction (AMI) patients and of optical coherence tomography (OCT)-defined thin-cap fibroatheroma (TCFA) to identify non-culprit vulnerable plaques. AIMS: We sought to systematically compare long-term NCL-related clinical prognosis in an AMI population utilising acute Murray fractal law-based QFR (μQFR) values and OCT-defined TCFA. METHODS: Three-vessel OCT imaging and μQFR assessment were conducted in 645 AMI patients, identifying 1,320 intermediate NCLs in non-infarct-related arteries. The primary endpoint was a composite of cardiac death, NCL-related non-fatal myocardial infarction (MI), and NCL-related unplanned coronary revascularisation, with follow-up lasting up to 5 years. RESULTS: The primary endpoint occurred in 59 patients (11.1%). OCT-defined TCFA independently predicted patient-level (adjusted hazard ratio [HR] 3.05, 95% confidence interval [CI]: 1.80-5.19) and NCL-specific primary endpoints (adjusted HR 4.46, 95% CI: 2.33-8.56). The highest event rate of 29.6% was observed in patients with NCLs that were TCFA (+) with μQFR ≤0.80, compared to 16.3% in those that were also TCFA (+) but with μQFR>0.80, 6.0% in those that were TCFA (-) with μQFR ≤0.80, and 6.6% in those that were TCFA (-) with μQFR>0.80 (log-rank p<0.001). TCFA was an independent predictor for the primary endpoint in ST-segm...