Coronary physiology indicators for assessing the stenosis functional significance in non-infarct-related arteries in patients with ST-segment elevation myocardial infarction

Aim . To study the informative value of invasive coronary physiology indices (fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR)) and to evaluate the safety of papaverine as a hyperemic agent to determine the hemodyna­mic significance of stenoses in non-infarction-related arteries (non-IRA) in patients with ST-seg­ment elevation myocardial infarction (STEMI) during the index procedure after primary percutaneous coronary intervention (PPCI). Material and methods . This single-center prospective study included 32 patients over 18 years of age with STEMI and 50-85% stenosis in 38 non-IRA. After PPCI of the infarction-related artery, iFR, contrast-enhanced FFR, and (if there were no contraindications) FFR with papaverine were measured. Rehospitalization was performed 30-45 days later with follow-up coronary angiography and reassessment of physiological parameters. Statistical analysis included Spearman’s rank order coefficient (SRCC), intraclass correlation (ICC), Cohen’s kappa coefficient, Bland-Altman analysis, and McNemar’s test (α=0,05). Results . Analysis of 38 non-IRAs (36 FFR tests with papaverine) demonstrated high reproducibility as follows: iFR — ρ=0,94 (p