Angiography-derived microcirculatory resistance predicts left ventricular ejection fraction decline in STEMI pa-tients undergoing primary percutaneous coronary inter-vention
YE Jing-guang
WANG Jia-jie
LUO De-mou
LIU Jie-liang
ZHANG Ying
DONG Hao-jian
Abstract：Background Coronary microvascular dysfunction (CMD) is a critical pathological mechanism underlying left ventricular ejection fraction (LVEF) decline after primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction (STEMI) patients. Angiography-derived microcirculatory resistance (AMR), a novel wire-free index, offers noninvasive assessment of CMD. This study aimed to validate AMR's predictive value for post-PPCI LVEF impairment. Methods A total of 190 STEMI patients who underwent PPCI at four centers between March 2017 and May 2022 were retrospectively enrolled. Patients were categorized into two groups based on whether their LVEF was below 50% when measured after 72 hours post-PPCI: the normal LVEF group (n=114) and the reduced LVEF group (n=76). The clinical characteristics of the two groups were compared. AMR was computed using quantitative flow ratio (QFR) analysis. Multivariable logistic regression, linear regression, and receiver operating characteristic (ROC) curves were applied to assess predictive performance. Results The reduced LVEF group exhibited significantly higher post-PPCI AMR (268 mmHg·s/m vs. 229 mmHg·s/m, P<0.001) compared to the normal LVEF group. Multivariable logistic and linear regression confirmed that elevated AMR (OR: 1.01; 95%CI: 1.00-1.02, P=0.001) was an independent predictor of LVEF decline to <50% after PPCI. ROC analysis revealed a moderate predictive capacity of AMR, with an area under the curve (AUC) of 0.684 (95%CI: 0.608-0.760). The optimal AMR cutoff of 262.5 mmHg·s/m demonstrated 55.26% sensitivity and 72.81% specificity for identifying LVEF decline in reperfused STEMI patients. Conclusions Post-PPCI AMR was an independent predictor of LVEF decline to <50% in STEMI patients. The data demonstrated that an AMR threshold of ≥262.5 mmHg·s/m after PPCI was associated with a statistically significant increase in the likelihood of LVEF reduction compared to individuals with AMR values within the normal range. [S Chin J Cardiol 2025;26(4):207-218]
Keywords：ST-elevation myocardial infarctionPrimary percutaneous coronary interventionLeft ventricular ejection fractionAngiography-derived microcirculatory resistance
Publication Date：2025-12-30
Online Publishing Date：2026-01-27(First online date of this platform, not the publication date of the document)
Pages：13( 207-218,258 )