Abstract 4144306: Relation Between Periprocedural Acute Myocardial Infarction And Coronary Microcirculation In Elective Percutaneous Coronary Intervention

Background: Coronary microvascular dysfunction in patients with stable coronary artery disease (CAD) predicts worse long-term clinical outcomes. Whether the dynamic changes of the microcirculation during elective percutaneous coronary intervention (PCI) might be associated with the occurrence of periprocedural acute myocardial infarction (pMI) is still unknown. Objective: In this study we aimed to investigate the impact of pre and post-PCI angiographic-derived index of microcirculatory resistance (AMR), coronary flow velocity ratio (CFVR) and μFR on periprocedure myocardial infarction (pMI). Methods: Between June 2021 and December 2023, patients with CAD who underwent elective PCI at a tertiary hospital in Brazil, were considered for inclusion; patients with side branch occlusion were excluded. All eligible patients underwent microcirculation analysis using AngioPlus Core (Shanghai Pulse Medical Technology Inc). The primary outcome was the incidence of pMI, as defined by the Fourth universal Definition (4thU) and by the Society for Cardiovascular Angiograph&Interventions (SCAI) criterias. Results: 330 patients were included into the analysis. Figure 1 (A-D) shows the behavior of epicardial pressure and flow and, the microvascular resistance according to the occurrence of pMI. Dynamic changes in coronary microcirculation, lead to differences between the delta of μFR, AMR and CFVR pre and post-PCI, which are correlated with pMI in patients undergoing elective PCI. The best parameter to predict pMI was delta AMR (4thU AUC 0.64; SCAI AUC 0.68; Figure 1A). Patients who developed pMI, presented significantly higher values of delta μFR (4thU p< 0.001; SCAI p 0.04; Figure 1B) and delta AMR (4thU p < 0.001; SCAI p = 0.005; Figure 1C). There is a tendency for CFVR to decrease in pMI population, as seen in delta CFVR value (4thU p = 0.03; SCAI p = 0.007; Figure 1D). Conclusion: Computational angiographic-derived indexes were able to identify patients with pMI undergoing elective PCI irrespective of the pMI definition. These indexes have potential utility in clinical practice for patient’s risk stratification.