Evaluating the Efficacy of AI-Assisted Quantitative Coronary Angiography in Reducing Procedural Time for Primary PCI in STEMI Patients: A Retrospective Analysis

Abstract

Background: Rapid reperfusion is crucial in ST-elevation myocardial infarction (STEMI). We investigated whether AI-assisted quantitative coronary angiography (QCA) can reduce the procedure time for primary percutaneous coronary intervention (PCI) in patients with STEMI. Methods: This single-center, retrospective study compared primary PCI assisted by MPXA, an AI-based QCA software, with angiography-guided PCI in 1,041 patients with STEMI. To minimize potential bias, a 1:3 propensity score matching was performed between the treatment and control groups. The primary endpoint was the time from coronary angiography to PCI completion. The secondary endpoints included total contrast media volume during the procedure, in-hospital mortality, and in-hospital cardiac death. Results: After propensity score matching, 164 and 492 patients in the AI-QCA-assisted and angiography-guided groups, respectively, were analyzed. The AI-QCA-assisted PCI group showed significant reduction in procedure time than the angiography-guided PCI group (34.9 ± 13.9 vs. 39.5 ± 17.1 minutes, P < 0.001). There was no significant difference in contrast media volume between the two groups (132.0 ± 42.2 vs. 135.8 ± 48.0 mL, P = 0.354). Furthermore, no significant differences were observed in in-hospital mortality (2.4% vs. 3.0%, P = 0.692) or cardiac mortality (2.4% vs. 2.8%, P = 0.786) between the AI-QCA-assisted PCI and control groups. Conclusion: AI-assisted QCA significantly reduced the overall procedure time of primary PCI for STEMI, primarily by streamlining stent sizing and optimization processes without decreasing contrast use. Given that STEMI procedures typically begin with small-diameter balloon inflation to maintain blood flow and minimize complications, the time saved by optimal stent deployment could be clinically beneficial by allowing faster complete reperfusion. Larger studies are needed to confirm the potential clinical benefit of reducing the procedure time using AI-QCA in STEMI treatment.