Correlation between abnormal microvascular perfusion and quantitative flow ratio after primary PCI in patients with STEMI

Abstract

Aims: Timely assessment of abnormal microvascular perfusion (MVP) may improve prognosis in patients with ST-segment elevation myocardial infarction (STEMI). This study aimed to determine the clinical implications of contrast-flow quantitative flow ratio (cQFR) in evaluating abnormal MVP and subsequent outcomes among STEMI patients after successful primary percutaneous coronary intervention (PPCI).

Methods: The study population consisted of 2 independent cohorts. The diagnostic cohort was used to evaluate the correlation and diagnostic accuracy of cQFR in predicting abnormal MVP. In this cohort, MVP and cQFR of the culprit vessel (n = 186) were assessed from a prospective consecutive registry. Abnormal MVP was determined using myocardial contrast perfusion echocardiography (MCE) in the culprit vessel after PPCI. The prognostic cohort consisted of STEMI patients undergoing PPCI who were followed for a minimum of 2 years (n = 1931). The primary outcome was all-cause mortality.

Results: In the diagnostic cohort, cQFR exhibited a moderate correlation with abnormal MVP assessed by MCE. Specificity, sensitivity, and area under the curve of post-PPCI cQFR to predict abnormal MVP were 81.6 %, 50.9 % and 0.709 (95 % confidence interval: 0.635-0.783), respectively, with the best cut-off value of 0.875. In the prognostic cohort, patients with cQFR <0.875 showed a significantly higher risk of long-term mortality compared to those with cQFR ≥0.875 (median follow-up: 52 months; mortality: 8.0 % vs. 3.8 %; p < 0.001). Cox-regression analysis revealed that cQFR < 0.875 was an independent predictor of long-term mortality (adjusted HR: 2.132; 95 % CI: 1.358-3.346; p = 0.001) after adjusting for age, gender, diabetes mellitus, hyperlipidemia, symptom to balloon time, culprit vessel.

Conclusions: We found that cQFR demonstrated a relatively good performance in predicting abnormal MVP in patients with STEMI after successful PPCI. A cQFR value below 0.875 is an independent predictor of both abnormal MVP and long-term mortality. (Prognostic implication of cQFR in STEMI patients; NCT04996901).

Keywords: Microvascular perfusion; Myocardial contrast perfusion echocardiography; Quantitative flow ratio.