Original Research

DOI: 10.4244/EIJ-D-24-00720

Functional or anatomical assessment of non-culprit lesions in acute myocardial infarction

Xueming Xu1,2, MD; Chao Fang1,2, MD, PhD; Senqing Jiang1,2, MD, PhD; Yuzhu Chen1,2, MD; Jiawei Zhao1,2, MD; Sibo Sun1,2, MD; Yini Wang1,2, MD, PhD; Lulu Li1,2, MS; Dongxu Huang1,2, MD; Shuang Li1,2, MD; Huai Yu1,2, MD, PhD; Tao Chen1,2, MD, PhD; Jinfeng Tan1,2, MD; Xiaohui Liu1,2, MD, PhD; Jiannan Dai1,2, MD, PhD; Gary S. Mintz3, MD; Bo Yu1,2, MD, PhD

Abstract

Background: Previous studies have reported the value of quantitative flow ratio (QFR) to assess the physiological significance of non-culprit lesions (NCLs) in acute myocardial infarction (AMI) patients and of optical coherence tomography (OCT)-defined thin-cap fibroatheroma (TCFA) to identify non-culprit vulnerable plaques.

Aims: We sought to systematically compare long-term NCL-related clinical prognosis in an AMI population utilising acute Murray fractal law-based QFR (μQFR) values and OCT-defined TCFA.

Methods: Three-vessel OCT imaging and μQFR assessment were conducted in 645 AMI patients, identifying 1,320 intermediate NCLs in non-infarct-related arteries. The primary endpoint was a composite of cardiac death, NCL-related non-fatal myocardial infarction (MI), and NCL-related unplanned coronary revascularisation, with follow-up lasting up to 5 years.

Results: The primary endpoint occurred in 59 patients (11.1%). OCT-defined TCFA independently predicted patient-level (adjusted hazard ratio [HR] 3.05, 95% confidence interval [CI]: 1.80-5.19) and NCL-specific primary endpoints (adjusted HR 4.46, 95% CI: 2.33-8.56). The highest event rate of 29.6% was observed in patients with NCLs that were TCFA (+) with μQFR ≤0.80, compared to 16.3% in those that were also TCFA (+) but with μQFR>0.80, 6.0% in those that were TCFA (–) with μQFR ≤0.80, and 6.6% in those that were TCFA (–) with μQFR>0.80 (log-rank p<0.001). TCFA was an independent predictor for the primary endpoint in ST-segment elevation MI (STEMI; adjusted HR 3.27, 95% CI: 1.67-6.41) and non-STEMI (adjusted HR 3.26, 95% CI: 1.24-8.54) patients, whereas μQFR ≤0.80 was not.

Conclusions: When assessing NCLs during the index procedure in AMI patients, OCT-defined TCFA serves as the dominant prognostic predictor for long-term clinical outcomes, rather than μQFR-determined physiological significance.

Sign in to read
the full article

Forgot your password?
No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

Volume 21 Number 4
Feb 17, 2025
Volume 21 Number 4
View full issue


Key metrics

Suggested by Cory

CLINICAL RESEARCH

10.4244/EIJV12I6A116 Aug 20, 2016
Culprit plaque morphology in STEMI – an optical coherence tomography study: insights from the TOTAL-OCT substudy
Kajander O et al
free

Clinical research

10.4244/EIJ-D-22-00306 Feb 6, 2023
Long-term outcomes of patients with normal fractional flow reserve and thin-cap fibroatheroma
Fabris E et al
free

CLINICAL RESEARCH

10.4244/EIJV11I3A59 Jul 20, 2015
Serial optical coherence tomography imaging of ACS-causing culprit plaques
Souteyrand G et al
free

Clinical research

10.4244/EIJ-D-22-00562 Jan 23, 2023
Outcomes of non-ischaemic coronary lesions with high-risk plaque characteristics on coronary CT angiography
Yang S et al
free
Trending articles
172.05

Focus article

10.4244/EIJY19M08_01 Jan 17, 2020
EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update
Glikson M et al
free
42

Original Research

10.4244/EIJ-D-25-00331 May 21, 2025
One-month dual antiplatelet therapy followed by prasugrel monotherapy at a reduced dose: the 4D-ACS randomised trial
Jang Y et al
open access
26.5

Expert Review

10.4244/EIJ-D-24-00535 May 5, 2025
Catheter-based techniques for pulmonary embolism treatment
Costa F et al
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 9.5
2024 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2025)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2025 Europa Group - All rights reserved