Although percutaneous coronary intervention (PCI) is capable of successfully reopening the occluded vessels beneath the epicardium in patients with acute myocardial infarction (AMI), a considerable proportion of patients experience coronary microvascular dysfunction (CMD) post-PCI, and this significantly affects the recovery of long-term cardiac function. Nevertheless, the dynamic change trends of early microcirculation perfusion after PCI therapy on cardiac function at different periods remain undefined.

To examine the influence of early coronary microcirculation perfusion following PCI on the left ventricular remodeling and functional changes at different postoperative time points in AMI patients.

A total of 98 AMI patients successfully treated with PCI in the Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine from June 2021 to June 2023 were divided into two groups based on myocardial contrast echocardiography (MCE) findings on 2-7 days postoperatively: the normal coronary microcirculation perfusion (NOR) group (n=41) and microvascular perfusion abnormalities (MPA) group (n=57). Echocardiographic assessments of left ventricular systolic and diastolic function were performed at 2-7 days, 2 months, and 12 months postoperatively. Clinical data from both groups were collected and subjected to statistical analysis.

Compared with the NOR group, patients in the MPA group exhibited higher brain natriuretic peptide (BNP) levels (P<0.001), lower proportion of preoperative standardized medication use (P=0.025), higher proportion of ST-segment elevation myocardial infarction (STEMI) (P=0.032). Compared with the NOR group, patients in the MPA group exhibited lower left ventricular ejection fraction (LVEF) and absolute values of global longitudinal strain (GLS) at 2-7 days, 2 months, and 12 months postoperatively. Additionally, the left ventricular internal diameter at end-diastole (LVIDd), left ventricular internal diameter at end-systole (LVIDs), left ventricular end-diastolic volumetric capacity (LVEDV) and left ventricular end-systolic volumetric capacity (LVESV), and anteroposterior diameter of the left atrium (LAD') were larger in the MPA group than the NOR group (P<0.05). Furthermore, the ratio of early mitral inflow velocity to early diastolic velocity of the mitral annulus (E/e') at 12 months postoperatively was significantly higher than that in the NOR group (P<0.05). Compared with the 2-7 days postoperative period, patients in both groups exhibited significant improvements in LVEF and absolute values of GLS at 2 months and 12 months after PCI. Additionally, LVEDV and LVESV were significantly reduced during these follow-up periods (P<0.05). Spearman correlation analysis revealed that early microcirculation perfusion after PCI was negatively correlated with LVEF changes from 2-7 days to 12 months postoperatively (r_s=-0.305, P=0.019) and from 2 months to 12 months postoperatively (r_s=-0.279, P=0.034). In contrast, it was positively correlated with LVEF changes from 2-7 days to 2 months postoperatively (r_s=0.276, P=0.019). Multivariate Logistic regression analysis showed that LVEF (2-7 days after PCI) (OR=0.151, 95%CI=0.040-0.568, P=0.005) and myocardial perfusion (OR=0.098, 95%CI=0.026-0.366, P<0.001) were independent risk factors for recover in left ventricular function at 12 months after PCI in AMI patients.

The early microcirculation perfusion level following PCI in AMI patients is associated with subsequent left ventricular functional alterations. Patients with poor early microcirculation perfusion exhibit poorer left ventricular systolic function. Even if there is a marked improvement in the short term, the long-term recovery remains unsatisfactory.