Determinants and Prognoses of Visual-Functional Mismatches After Mechanical Reperfusion in ST-Elevation Myocardial Infarction

Figures & data

Figure 1 Flow chart of patients’ enrollment.

Table 1 Baseline Information

	Concordantly Negative n=67	Mismatch n=68	Reverse Mismatch n=51	Concordantly Positive n=124	P value
Age, years	61.79±14.20	63.13±12.04	61.96±13.72	60.75±12.14	0.672
Sex					0.647
Male	55(82.1)	55(80.9)	44(86.3)	108(87.1)
Female	12(17.9)	13(19.1)	7(13.7)	16(12.9)
Hypertension	30(44.8)	29(42.6)	24(47.1)	58(46.8)	0.952
Diabetes	4(6.0)	9(13.2)	5(9.8)	17(13.7)	0.395
Smoking	44(65.7)	35(51.1)	30(58.8)	63(50.8)	0.205
History of MI	6(9.0)	4(5.9)	2(3.9)	6(4.8)	0.658
Glycated hemoglobin A1c (%)	6.00(5.50–6.40)	5.90(5.43–6.80)	5.90(5.50–6.60)	5.90(5.60–6.40)	0.983
Dyslipidemia	34(50.7)	47(70.6)	34(66.7)	86(69.4)	0.051
TC (mmol/L)	4.84(4.11–5.32)	4.71(3.65–5.64)	4.70(3.53–5.67)	4.97(4.10–5.95)	0.416
TG (mmol/L)	1.56(1.12–2.28)	1.65(1.10–2.38)	1.62(1.19–2.89)	1.63(1.14–2.77)	0.644
LDL-C (mmol/L)	3.30(2.58–3.60)	3.31(2.51–3.88)	3.36(2.67–3.90)	3.45(2.84–4.19)	0.094
HDL-C (mmol/L)	1.18(0.95–1.41)	1.13(0.95–1.32)	1.11(0.91–1.30)	1.19(0.90–1.36)	0.418
Killip class					0.112
I	54(80.6)	51(75.0)	39(76.5)	98(79.0)
II	9(13.4)	10(14.7)	12(23.5)	22(17.7)
III	1(1.5)	0(0)	0(0)	2(1.6)
IV	3(4.5)	7(10.3)	0(0)	2(1.6)
LVEF (%)	55.00(48.00–65.00)	52.74(46.25–60.00)	52.74(42.00–59.00)	52.74(46.00–55.75)	0.043
Max CK-MB (U/L)	205.62(68.66–322.00)	185.10(61.53–347.75)	92.60(34.10–226.00)	99.20(38.33–257.45)	0.028
cTnI/cTnT > 100 times	52(77.6)	54(79.4)	38(74.5)	96(77.4)	0.938
BNP/NT-proBNP > 10 times	16(23.9)	19(27.9)	14(27.5)	38(30.6)	0.812

Note: Data are presented as number (%), mean ± SD, or median (interquartile range).

Abbreviations: cTnT, Cardiac troponin T; cTnI, Cardiac troponin I; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal prohormone of the B-type natriuretic peptide; BNP, Brain natriuretic peptide; TC, Total cholesterol; TG, Total triglycerides; LDL-c, Low-density lipoprotein cholesterol; HDL-c, High-density lipoprotein cholesterol; MI, myocardial infarction; CK-MB, Creatine kinase-myocardial band.

Table 2 Angiographic Results

	Concordantly negative n=67	Mismatch n=68	Reverse mismatch n=51	Concordantly positive n=124	P value
Culprit vessel					0.074
LAD	28(41.8)	29(42.6)	33(64.7)	74(59.7)
RCA	32(47.8)	32(47.1)	15(29.4)	41(33.1)
LCX	7(10.4)	7(10.3)	3(5.9)	9(7.3)
No-/slow-reflow phenomenon	3(4.5)	1(1.5)	3(5.9)	9(7.3)	0.356
Thrombus aspiration	15(22.4)	13(19.1)	8(15.7)	31(25.0)	0.560
Tirofiban used	26(38.8)	29(42.6)	26(51.1)	50(40.3)	0.554
TIMI score					0.739
2	13(19.4)	9(13.2)	9(17.6)	24(19.4)
3	54(80.6)	59(86.8)	42(82.4)	100(80.6)
Physiological indices
QFR	0.89±0.05	0.87±0.04	0.62±0.17	0.58±0.19	<0.001
AMR (mmHg*s/m)	270.40±111.35	270.72±96.44	171.55±76.13	167.72±81.26	<0.001
CFV (cm/s)	15.50(12.50–18.80)	14.20(11.00–17.45)	16.80(13.90–21.50)	15.80(13.40–19.08)	0.028
QCA analysis
DS (%)	33.42±14.83	68.63±12.91	28.99±18.51	68.28±11.84	<0.001
AS (%)	58.52±20.56	80.06±26.19	70.56±17.89	79.83±26.31	<0.001
LL (mm)	14.17±7.34	12.73±6.06	13.58±8.32	15.85±9.37	0.065
MLD (mm)	1.60(1.34–1.90)	0.83(0.58–1.34)	1.31(1.10–1.70)	0.95(0.69–1.34)	<0.001
MLA (mm^2)	2.17(1.73–2.17)	0.64(0.26–1.86)	2.17(1.13–2.27)	0.84(0.39–2.17)	<0.001

Note: Data are presented as number (%), mean ± SD, or median (interquartile range).

Abbreviations: LAD, left anterior descending coronary artery; LCX, left circumflex coronary artery; RCA, right coronary artery; TIMI, thrombolysis in myocardial infarction; QFR, quantitative flow ratio; CFV, coronary flow velocity; AMR, angiography-derived microcirculatory resistance; QCA, quantitative coronary angiography; AS, area stenosis; DS, diameter stenosis; LL, lesion length; MLD, minimal lumen diameter; MLA, minimal lumen area.

Figure 2 Comparison of the occurrence of QCA-QFR concordance/discordance after mechanical reperfusion.

Table 3 Determinants of Reverse Mismatch (QFR ≤ 0.80) in Visually Nonsignificant Lesions (DS ≤ 50%)

	Univariable			Multivariable
	Odds Ratio	95% CI	P value	Odds Ratio	95% CI	P value
Age	1.001	0.975–1.028	0.948
Male	0.729	0.265–2.008	0.541
Hypertension	1.096	0.528–2.227	0.805
Diabetes	1.712	0.436–6.728	0.441
Smoking	0.747	0.352–1.584	0.447
Dyslipidemia	1.941	0.913–4.125	0.085	0.671	0.209–2.152	0.502
LVEF	0.965	0.935–0.997	0.033	0.959	0.911–1.010	0.114
History of MI	0.415	0.080–2.148	0.294
LAD lesion	2.488	0.954–6.487	0.062	1.439	0.315–6.578	0.639
Thrombus aspiration	0.645	0.250–1.665	0.365
Tirofiban use	1.640	0.785–3.426	0.188
MLD	0.497	0.246–1.002	0.050	1.249	0.390–4.001	0.708
MLA	0.889	0.697–1.135	0.346
DS	0.984	0.962–1.006	0.151
AS	1.038	1.013–1.065	0.003	1.044	1.004–1.086	0.032
LL	0.990	0.944–1.038	0.684
CFV	1.057	0.995–1.122	0.072	0.690	0.567–0.838	<0.001
AMR	0.979	0.970–0.988	<0.001	0.947	0.924–0.970	<0.001

Abbreviations: CI, confidence interval; LVEF, left ventricular ejection fraction; MI, myocardial infarction, LAD, left anterior descending coronary artery; MLD, minimal lumen diameter; MLA, minimal lumen area; DS, diameter stenosis; AS, area stenosis; LL, lesion length; CFV, coronary flow velocity; AMR, angiography-derived microcirculatory resistance.

Table 4 Determinants of Mismatch (QFR > 0.80) in Visually Significant Lesions (DS > 50%)

	Univariable			Multivariable
	Odds Ratio	95% CI	P value	Odds Ratio	95% CI	P value
Age	1.016	0.992–1.042	0.194
Male	1.595	0.716–3.553	0.253
Hypertension	0.846	0.466–1.536	0.583
Diabetes	0.960	0.403–2.288	0.927
Smoking	0.974	0.539–1.760	0.930
Dyslipidemia	1.060	0.556–2.024	0.859
LVEF	1.008	0.980–1.036	0.594
History of MI	1.229	0.335–4.516	0.756
LAD lesion	0.491	0.219–1.103	0.085	0.694	0.255–1.891	0.475
Thrombus aspiration	0.709	0.342–1.469	0.355
Tirofiban use	1.101	0.604–2.005	0.754
MLD	0.818	0.551–1.213	0.317
MLA	0.906	0.757–1.084	0.282
DS	1.002	0.978–1.027	0.846
AS	1.000	0.989–1.012	0.952
LL	0.953	0.916–0.991	0.017	0.961	0.918–1.006	0.092
CFV	0.986	0.921–1.017	0.198
AMR	1.017	1.011–1.023	<0.001	1.016	1.010–1.022	<0.001

Abbreviations: CI, confidence interval; LVEF, left ventricular ejection fraction; MI, myocardial infarction, LAD, left anterior descending coronary artery; MLD, minimal lumen diameter; MLA, minimal lumen area; DS, diameter stenosis; AS, area stenosis; LL, lesion length; CFV, coronary flow velocity; AMR, angiography-derived microcirculatory resistance.

Figure 3 Kaplan–Meier curves for 18-month MACE-free survival between the four groups.

Notes: G1 (Concordantly negative, QCA-DS ≤ 50% and QFR > 0.80), n=67; G2 (Mismatch, QCA-DS > 50% and QFR > 0.80), n=68; G3 (Reverse mismatch, QCA-DS ≤ 50% and QFR ≤ 0.80), n=51; G4 (Concordantly positive, QCA-DS > 50% and QFR ≤ 0.80), n=124.