| Objectives:The coronary functional changes of non-culprit coronary lesion and the timing of interventional treatment in patients with acute myocardial infarction(AMI)are currently controversial.This project intends to study the differences of quantitative flow ratio(QFR)and related influencing factors of non-culprit artery lesion in patients with AMI in the acute and non-acute phases,thus providing the new clinical evidence for clarifying the optimal therapeutic time and strategy for non-culprit artery lesion in myocardial infarction.Methods:A total of consecutive 190 patients underwent emergentpercutaneous coronary intervention(PCI)for AMI and coronary angiography for reexamination within 3 months in Hunan Provincial People’s Hospital from January 1,2019 to December 31,2020 and were enrolled in the study.A blind method was used to analyze the QFR values of non-culprit artery lesion with severe stenosis(50%-90%)in the acute and non-acute phases.In the same period,the clinical data of the patients were collected,including age,sex,body mass index,past history,echocardiography,serological and biochemical parameters,medication after discharge,hemodynamic characteristics(invasive blood pressure and heart rate in the acute phase and stable phase of myocardial infarction).The generalized linear model were used to analyze the relationship between the above factors and the QFR change rate to identify the clinical related influencing factors.Results:1.A total of 190 patients with AMI were admitted in the study,with a total of 223 non-culprit artery.A total of 112(58.9%)and 78(41.1%)patients presented with ST segment elevation myocardial infarction(STEMI)and non-ST segment elevation myocardial infarction(NSTEMI)respectively.The average age was 63.57± 11.57 years,73.7%were man,and the average body mass index was 25.47± 2.38Kg/m~2.In terms of past history of the included AMI patients,50.0%had hypertension,32.1%had diabetes,20.0%had dyslipidemia and 51.1%smoked.The culprit artery in AMI patients were mostly left anterior descending artery(43.5%)and right coronary artery(43.5%),and circumflex branch accounted for13.0%.2.The comparison of coronary physiology assessment results of non-culprit artery of AMI in acute and non-acute stages indicated significant differences of vascular QFR,lesion QFR,diameter stenosis rate and area stenosis rate in varied phases.(p<0.05).3.Univariate correlation analysis showed that the QFR change rate was correlated with diastolic pressure,systolic pressure,mean arterial pressure and heart rate in the acute phase of myocardial infarction,and the difference of mean arterial pressure between acute and non acute phases of myocardial infarction(p<0.05).Multiple-factor analysis showed that the major influencing factors of QFR change rate included diastolic pressure,systolic pressure and mean arterial pressure in the acute phase of myocardial infarction,and the difference of mean arterial pressure between acute and non acute phases of myocardial infarction(p<0.05).4.The blood pressure stratification analysis showed that when diastolic blood pressure<60 mm Hg and/or systolic blood pressure<90mm Hg were negatively correlated with the QFR change rate,with the partial regression coefficients of-0.292 and-0.546,respectively.In the acute phase of myocardial infarction,QFR values changed by 2.92%for every 10 mm Hg decrease in diastolic pressure,and by 5.46%for every 10mm Hg decrease in systolic pressure.Conclusion:The difference of the QFR values of non-culprit artery in AMI patients between the acute and non acute phases of myocardial infarction is mainly influenced by hemodynamic factors,particularly the perfusion pressure in acute phase of AMI;When systolic pressure of AMI patients is less than 90mm Hg and/or diastolic pressure is less than 60mmhg,the coronary physiology assessment of non-culprit lesion after blood pressure stablization can further optimize the interventional strategy. |
PDF Full Text Request