Predictive value of noninvasive myocardial work indices in guiding revascularization of associated intermediate non culprit coronary lesions in acute coronary syndromes patients

Abstract Background A significant proportion of patients with acute coronary syndromes (ACS) present with multivessel disease. In such cases, staged revascularization of both culprit and non-culprit lesions reduces adverse events. Intermediate coronary lesions (40–70% diameter stenosis) are particularly challenging to assess. While fractional flow reserve (FFR) is a validated standard for determining lesion significance, its widespread use is hindered by cost and invasiveness. Recently, noninvasive myocardial work (MW) indices derived from speckle tracking echocardiography (STE) and blood pressure measurements have emerged as promising tools for evaluating myocardial efficiency and ischemia. Aim To evaluate the predictive accuracy of regional MW indices—namely regional work index (RWI) and regional work efficiency (RWE)—in identifying functionally significant intermediate coronary lesions compared to FFR (reference standard) and optical coherence tomography (OCT) findings. Methods We prospectively studied 123 patients with a first ACS, admitted within 7 days, with at least one non-culprit lesion (40–70% stenosis) and no wall motion abnormalities outside the culprit territory. Patients underwent FFR, OCT, and PCI (if indicated) for non-culprit lesions. Echocardiographic assessment with 2D STE was performed 2–7 days post-ACS, calculating regional MW indices based on the 17-segment AHA model. Revascularization decisions guided by FFR