In NSTEMI patients after PCI, 3VA-AMR ≥250 mmHg*s/m independently doubled 2-year MACE risk (21.90% vs. 10.27%, OR 2.535, AUC 0.701).
Does high average three vessels microvascular resistance (3VA-AMR) predict 2-year MACE in patients with NSTEMI after PCI?
In NSTEMI patients undergoing PCI, an average three-vessel microvascular resistance ≥250 mmHg*s/m derived from QFR analysis is an independent predictor of 2-year MACE.
Abstract Objectives Angle-based microvascular resistance (AMR) is a parameter in Quantitative flow ratio(QFR) analysis reflecting the microvascular function of coronary arteries. We investigated the predictive value of the average microvascular resistance of the three main vessels (3VA-AMR) for the prognosis of non-ST-segment elevation myocardial infarction (NSTEMI) patients after percutaneous coronary intervention (PCI). Methods This study was carried out on patients with NSTEMI who underwent PCI. QFR analysis was conducted on all patients' PCI angiography images, assessing postoperative QFR and AMR for three main vessels. All enrolled patients were segmented into two groups according to the standard of coronary microvascular dysfunction (CMD): high 3VA-AMR group and low 3VA-AMR group. The primary outcome was 2-year major adverse cardiac events (MACE), including cardiovascular death, myocardial infarction and ischemia-driven revascularization. Results A total of 290 patients were included in the final analysis. Compared with the low 3VA-AMR group, the high 3VA-AMR group had higher 3-vessel-average Quantitative Flow Ratio (3VA-QFR) 0.92±0.05 vs. 0.88±0.09, P0.001, higher 3VA-AMR 291.48±59.76 vs. 202.65±34.88, P0.001. The target vessels of high 3VA-AMR group had lower diameter stenosis 28.22±9.94 vs. 30.75±10.80, P=0.025 and area stenosis 47.63±13.66 vs. 50.80±14.42, P=0.037. The incidence of 2-year MACE was significantly higher in the high 3VA-AMR group than in the low 3VA-AMR group 21.90% vs. 10.27%, P=0.007. Univariate and multivariate logistics regression analysis confirmed that 3VA-AMR ≥250 mmHg*s/m was independently associated with 2-year MACE (OR:2.535, 95% CI:1.291-4.980, P=0.007). Receiver-operating characteristic (ROC) curve analysis showed 3VA-AMR and MACE correlation (area under the curve: 0.701, P0.001). And the prediction ability can be improved by combining with traditional prediction factors (area under the curve: 0.749, P0.001). Conclusions 3VA-AMR ≥250 mmHg*s/m was an independent risk factor for 2-year MACE in NSTEMI patients. 3VA-AMR improves the predictive ability of MACE when combined with traditional predictive factors.
Yan et al. (2025) studied this question. In NSTEMI patients after PCI, 3VA-AMR ≥250 mmHg*s/m independently doubled 2-year MACE risk (21.90% vs. 10.27%, OR 2.535, AUC 0.701).