{"title":"对急性心肌梗死患者非罪魁祸首血管进行彻底的生理评估：这是必需的吗？","authors":"Zining Chen, Yuxuan Zhang, Jiacheng Fang, Yiyue Zheng, Delong Chen, Abuduwufuer Yidilisi, Xinyi Zhang, Chi Liu, Jiniu Huang, Rui Ji, Jiamu Chen, Guohui Chen, Ping Lin, Yumeng Hu, Jianping Xiang, Jian'an Wang, Jun Jiang","doi":"10.1007/s10557-025-07768-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Backgrounds: </strong>The management of non-culprit vessels (NCV) among individuals with acute myocardial infarction (AMI) remains an unsolved problem. Angiography-derived physiological assessments developed recently may help address this issue. Our study aims to measure angiography-derived fractional flow reserve (Angio-FFR) and angiography-derived index of microcirculatory resistance (Angio-IMR) in NCVs of AMI patients and explore their prognostic values and necessity.</p><p><strong>Methods: </strong>This retrospective cohort study enrolled AMI patients with multivessel disease (MVD) who were routinely followed up for 2 years. Angio-FFR and Angio-IMR were measured in NCVs with 40%-80% visual stenosis. The primary endpoint was defined as the vessel-oriented composite endpoint (VOCE), comprising cardiac death, target vessel myocardial infarction, and ischemia-driven target vessel revascularization.</p><p><strong>Results: </strong>A total of 503 patients and 712 NCVs were retrospectively included. NCVs with Angio-FFR ≤ 0.8 had significantly higher hazards of VOCE (27% vs. 12.6%, P < 0.001), contrarily, Angio-IMR groups divided by 25 exhibited no significant discrepancy (15.15% vs. 11.04%, P = 0.383). Multivariate Cox regression identified Angio-FFR as an independent predictor of VOCE (HR: 1.70, 95% CI: 1.01-2.84, P < 0.05), whereas Angio-IMR did not (HR: 0.88, 95% CI: 0.43-1.79, P > 0.05). Such correlation was consistent in subgroup analysis and propensity score matching.</p><p><strong>Conclusions: </strong>The prognosis of NCVs in AMI patients correlated with Angio-FFR but not with Angio-IMR, indicating it is epicardial vessel occlusion rather than microcirculatory dysfunction, predominantly leading to additional adverse prognosis. Compared to Angio-FFR, measuring Angio-IMR could be of limited necessity and clinical value in the management of NCVs among AMI patients.</p><p><strong>Trial registration: </strong>URL: https://www.</p><p><strong>Clinicaltrials: </strong>gov . Unique identifier: NCT05696379. Study Registration Dates: 2022-12-13.</p>","PeriodicalId":9557,"journal":{"name":"Cardiovascular Drugs and Therapy","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Thorough Physiological Assessment in Non-Culprit Vessels of Patients with Acute Myocardial Infarction: Is It a Required Action?\",\"authors\":\"Zining Chen, Yuxuan Zhang, Jiacheng Fang, Yiyue Zheng, Delong Chen, Abuduwufuer Yidilisi, Xinyi Zhang, Chi Liu, Jiniu Huang, Rui Ji, Jiamu Chen, Guohui Chen, Ping Lin, Yumeng Hu, Jianping Xiang, Jian'an Wang, Jun Jiang\",\"doi\":\"10.1007/s10557-025-07768-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Backgrounds: </strong>The management of non-culprit vessels (NCV) among individuals with acute myocardial infarction (AMI) remains an unsolved problem. Angiography-derived physiological assessments developed recently may help address this issue. Our study aims to measure angiography-derived fractional flow reserve (Angio-FFR) and angiography-derived index of microcirculatory resistance (Angio-IMR) in NCVs of AMI patients and explore their prognostic values and necessity.</p><p><strong>Methods: </strong>This retrospective cohort study enrolled AMI patients with multivessel disease (MVD) who were routinely followed up for 2 years. Angio-FFR and Angio-IMR were measured in NCVs with 40%-80% visual stenosis. The primary endpoint was defined as the vessel-oriented composite endpoint (VOCE), comprising cardiac death, target vessel myocardial infarction, and ischemia-driven target vessel revascularization.</p><p><strong>Results: </strong>A total of 503 patients and 712 NCVs were retrospectively included. NCVs with Angio-FFR ≤ 0.8 had significantly higher hazards of VOCE (27% vs. 12.6%, P < 0.001), contrarily, Angio-IMR groups divided by 25 exhibited no significant discrepancy (15.15% vs. 11.04%, P = 0.383). Multivariate Cox regression identified Angio-FFR as an independent predictor of VOCE (HR: 1.70, 95% CI: 1.01-2.84, P < 0.05), whereas Angio-IMR did not (HR: 0.88, 95% CI: 0.43-1.79, P > 0.05). Such correlation was consistent in subgroup analysis and propensity score matching.</p><p><strong>Conclusions: </strong>The prognosis of NCVs in AMI patients correlated with Angio-FFR but not with Angio-IMR, indicating it is epicardial vessel occlusion rather than microcirculatory dysfunction, predominantly leading to additional adverse prognosis. Compared to Angio-FFR, measuring Angio-IMR could be of limited necessity and clinical value in the management of NCVs among AMI patients.</p><p><strong>Trial registration: </strong>URL: https://www.</p><p><strong>Clinicaltrials: </strong>gov . 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引用次数: 0
摘要
背景：急性心肌梗死（AMI）患者非罪犯血管（NCV）的管理仍然是一个未解决的问题。最近发展的血管造影衍生的生理评估可能有助于解决这个问题。我们的研究旨在测量AMI患者ncv的血管造影衍生分数血流储备（Angio-FFR）和血管造影衍生微循环阻力指数（Angio-IMR），并探讨其预后价值和必要性。方法：本回顾性队列研究纳入AMI合并多血管疾病（MVD）患者，常规随访2年。血管- ffr和血管- imr在40%-80%视觉狭窄的ncv中测量。主要终点被定义为血管导向的复合终点（VOCE），包括心源性死亡、靶血管心肌梗死和缺血驱动的靶血管重建术。结果：回顾性分析共纳入503例患者和712例ncv。血管- ffr≤0.8的ncv发生VOCE的风险较高（27% vs. 12.6%, P < 0.05）。这种相关性在亚组分析和倾向评分匹配中是一致的。结论：AMI患者ncv的预后与Angio-FFR相关，但与Angio-IMR无关，提示是心外膜血管闭塞而非微循环功能障碍，主要导致额外的不良预后。与血管- ffr相比，测量血管- imr在AMI患者ncv管理中的必要性和临床价值有限。试用注册：网址：https://www.Clinicaltrials: gov。唯一标识符：NCT05696379。研究注册日期：2022-12-13。
Thorough Physiological Assessment in Non-Culprit Vessels of Patients with Acute Myocardial Infarction: Is It a Required Action?
Backgrounds: The management of non-culprit vessels (NCV) among individuals with acute myocardial infarction (AMI) remains an unsolved problem. Angiography-derived physiological assessments developed recently may help address this issue. Our study aims to measure angiography-derived fractional flow reserve (Angio-FFR) and angiography-derived index of microcirculatory resistance (Angio-IMR) in NCVs of AMI patients and explore their prognostic values and necessity.
Methods: This retrospective cohort study enrolled AMI patients with multivessel disease (MVD) who were routinely followed up for 2 years. Angio-FFR and Angio-IMR were measured in NCVs with 40%-80% visual stenosis. The primary endpoint was defined as the vessel-oriented composite endpoint (VOCE), comprising cardiac death, target vessel myocardial infarction, and ischemia-driven target vessel revascularization.
Results: A total of 503 patients and 712 NCVs were retrospectively included. NCVs with Angio-FFR ≤ 0.8 had significantly higher hazards of VOCE (27% vs. 12.6%, P < 0.001), contrarily, Angio-IMR groups divided by 25 exhibited no significant discrepancy (15.15% vs. 11.04%, P = 0.383). Multivariate Cox regression identified Angio-FFR as an independent predictor of VOCE (HR: 1.70, 95% CI: 1.01-2.84, P < 0.05), whereas Angio-IMR did not (HR: 0.88, 95% CI: 0.43-1.79, P > 0.05). Such correlation was consistent in subgroup analysis and propensity score matching.
Conclusions: The prognosis of NCVs in AMI patients correlated with Angio-FFR but not with Angio-IMR, indicating it is epicardial vessel occlusion rather than microcirculatory dysfunction, predominantly leading to additional adverse prognosis. Compared to Angio-FFR, measuring Angio-IMR could be of limited necessity and clinical value in the management of NCVs among AMI patients.
Trial registration: URL: https://www.
Clinicaltrials: gov . Unique identifier: NCT05696379. Study Registration Dates: 2022-12-13.
期刊介绍：
Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field.
Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients.
Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.
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