Retinal and choroidal microvascular features associated with coronary slow flow after percutaneous coronary intervention for acute myocardial infarction: a prospective cross-sectional study using ultra-widefield swept-source optical coherence tomogra

Abstract Background Coronary slow flow (CSF) after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) may coexist with microvascular abnormalities beyond the epicardial coronary circulation. We examined whether retinal and choroidal features measured by ultra-widefield swept-source optical coherence tomography angiography (SS-OCTA) were associated with post-PCI CSF. Methods In this prospective cross-sectional study, 103 patients with AMI who underwent successful PCI were classified by corrected thrombolysis in myocardial infarction frame count (CTFC) into the CSF group (n = 58) and normal coronary flow (NCF) group (n = 45). SS-OCTA was performed 2–3 days after PCI. Between-group comparisons incorporated false discovery rate (FDR) correction. Exploratory correlations were assessed using Spearman rank correlation, and factors associated with CSF were evaluated using multivariable logistic regression. Model discrimination was assessed using receiver operating characteristic curves and area under the curve; calibration was assessed using 1,000 bootstrap resamples; and clinical utility was explored using decision curve analysis. Results After FDR correction, patients with CSF had lower deep capillary plexus vessel density (VD-DCP), choroidal vascularity index (CVI), and choroidal vascular volume (CVV) than patients with NCF. In multivariable logistic regression, higher white blood cell count (WBC; odds ratio [OR] = 1.491, 95% confidence interval [CI]: 1.184–1.878, P < 0.001) and neutrophil-to-platelet ratio (NPR; OR = 2.017, 95% CI: 1.160–3.508, P = 0.013) were associated with higher odds of CSF. Higher VD-DCP 0–12 mm (OR = 0.791, 95% CI: 0.699–0.896, P < 0.001) and CVI 0–12 mm (OR = 0.739, 95% CI: 0.617–0.886, P = 0.001) were inversely associated with CSF. The integrated model combining WBC, NPR, VD-DCP 0–12 mm, and CVI 0–12 mm had an apparent area under the curve of 0.910. Conclusions Post-PCI CSF in patients with AMI was associated with systemic inflammatory measures and selected retinal and choroidal microvascular features. The integrated model showed promising apparent discrimination, calibration, and clinical utility, but the cross-sectional, single-center findings require external and longitudinal validation.