Prognostic Value of Plaque Radial Wall Strain Analysis in Patients With Acute Myocardial Infarction After Complete Revascularization

ABSTRACT Background Even after complete revascularization (CR), patients with acute myocardial infarction (AMI) still face significant risks of adverse events, frequently linked to vulnerable plaque progression in nonsignificant stenosis. Aims To investigate the relationship between the radial wall strain (RWS) of nonsignificant stenosis lesions and major adverse cardiac events (MACE) in patients with AMI following CR. Methods This cohort study included patients with AMI who received CR of all culprit and non‐culprit lesions with diameter stenosis (DS%) > 70% during index or staged percutaneous coronary intervention within 45 days, with at least one de novo native lesion (DS% of 30%−70%) for RWS analysis. The primary outcome was MACE comprising cardiovascular death, nonfatal myocardial infarction, unstable angina, and heart failure. Results During a median follow‐up of 3.6 years, 55 among 225 patients (24.4%) experienced MACE, mainly driven by unstable angina. Maximum RWS (RWS max ) was predictive of MACE with an area under the curve of 0.84 (95% CI: 0.78−0.90; p < 0.001) and an optimal cutoff > 14.5%. In the multivariable Cox regression model, RWS max > 14.5% was an independent predictor for MACE among patients with AMI after CR (HR: 8.06; 95% CI: 3.98−16.35; p < 0.001). In patients with Murray law‐based quantitative flow ratio (μQFR) > 0.8, the prognostic impact of RWS max on MACE was comparable to that observed in patients with μQFR < 0.8 (P for interaction = 0.236). Conclusions Among patients with AMI who received CR, a high‐strain pattern detected by RWS analysis in nonsignificant stenosis lesions was associated with a worse clinical outcome.