Improved Nonculprit Stenosis Assessment in Patients With ST-Segment Elevation Myocardial Infarction Using Quantitative Flow Ratio

Lin, Wan‐Hua; Travieso, Alejandro; Hoeven, Nina van der; Leeuwen, Maarten A.H. van; Janssens, Gladys N.; Mejía‐Rentería, Hernán; Jerónimo, Adrián; Gonzalo, Nieves; Nijveldt, Robin; Royen, Niels van; Escaned, Javier

doi:10.1016/j.jcin.2023.04.045

Cited by 10 publications

(3 citation statements)

References 5 publications

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“…With respect to QFR, among patients with chronic coronary syndrome, QFR‐guided revascularization has been reported to improve 1‐year outcomes as compared with angiography‐guided revascularization. 19 Further, in patients with STEMI, acute QFR shows even better agreement with 30‐day FFR as acute FFR itself, 39 which in addition to its noninvasive and hyperemia‐free nature makes it an interesting diagnostic tool for the ACS population.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Flow Ratio to Predict Non–Target‐Vessel Events Before Planned Staged Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome

Bär,

Kavaliauskaite,

Otsuka

et al. 2024

JAHA

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Background The optimal time point of staged percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) remains a matter of debate. Quantitative flow ratio (QFR) is a novel noninvasive method to assess the hemodynamic significance of coronary stenoses. We aimed to investigate whether QFR could refine the timing of staged PCI of non‐target vessels (non‐TVs) on top of clinical judgment for patients with ACS. Methods and Results For this cohort study, patients with ACS from Bern University Hospital, Switzerland, scheduled to undergo out‐of‐hospital non‐TV staged PCI were eligible. The primary end point was the composite of non‐TV myocardial infarction and urgent unplanned non‐TV PCI before planned staged PCI. The association between lowest QFR per patient measured in the non‐TV (from index angiogram) and the primary end point was assessed using multivariable adjusted Cox proportional hazards regressions with QFR included as linear or penalized spline (nonlinear) term. QFR was measured in 1093 of 1432 patients with ACS scheduled to undergo non‐TV staged PCI. Median time to staged PCI was 28 days. The primary end point occurred in 5% of the patients. In multivariable analysis (1018 patients), there was no independent association between non‐TV QFR and the primary end point (hazard ratio, 0.87 [95% CI, 0.69–1.05] per 0.1 increase; P =0.125; nonlinear P =0.648). Conclusions In selected patients with ACS scheduled to undergo staged PCI at a median of 4 weeks after index PCI, QFR did not emerge as an independent predictor of non‐TV events before planned staged PCI. Thus, this study does not provide conceptual evidence that QFR is helpful to refine the timing of staged PCI on top of clinical judgment. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02241291.

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Section: Discussionmentioning

confidence: 99%

Quantitative Flow Ratio to Predict Non–Target‐Vessel Events Before Planned Staged Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome

Bär,

Kavaliauskaite,

Otsuka

et al. 2024

JAHA

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“…With respect to QFR, among patients with CCS, QFR-guided revascularization has been reported to improve 1-year outcomes as compared to angiography-guided revascularization 13 . Further, in STEMI patients, acute QFR shows even better agreement with 30-day FFR as acute FFR itself 29 , which in addition to its non-invasive and hyperemia-free nature, makes it an interesting diagnostic tool for the ACS population. Staged PCI QFR However, in our investigation, we did not observe any independent association between QFR and non-TV events occurring before staged PCI.…”

Section: In a Subanalysis Of The Compare-acute (Comparison Between Ff...mentioning

confidence: 97%

Quantitative Flow Ratio to Predict Non-Target-Vessel Events Prior to Planned Staged PCI in ACS Patients

Bär

Kavaliauskaite

Otsuka

et al. 2023

Preprint

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BackgroundThe optimal timepoint of staged percutaneous coronary intervention (sPCI) among patients with acute coronary syndrome (ACS) and multivessel disease (MVD) remains a matter of debate. Quantitative Flow Ratio (QFR) is a novel non-invasive method to assess the hemodynamic significance of coronary stenoses. We aimed to investigate whether QFR could optimize the timing of sPCI of non-target-vessels (non-TV) among ACS patients with MVD.MethodsFor this cohort study, ACS patients discharged from Bern University Hospital, Switzerland, were eligible if non-TV sPCI was scheduled within 6 months after index PCI. The primary endpoint was non-TV myocardial infarction (MI) and urgent unplanned non-TV PCI before planned sPCI. The association between lowest QFR per patient measured in non-TV (from index angiogram) and the primary endpoint was assessed using a multivariable adjusted Cox proportional hazards regression with QFR included as linear and penalized spline (non-linear) terms.ResultsQFR was measured in 1093/1432 ACS patients scheduled to undergo non-TV sPCI. Median time to sPCI was 28 days. The primary endpoint occurred in 5% of the patients. In multivariable analysis (1018 patients), there was no independent association between non-TV QFR and the primary endpoint (HR 0.87, 95% CI 0.69-1.05 [per 0.1 increase], p=0.125; non-linear p=0.648).ConclusionsIn ACS patients scheduled to undergo sPCI at a median of 4 weeks after index PCI, QFR did not emerge as independent predictor of non-TV events prior to planned sPCI. Thus, this study does not provide conceptual evidence, that QFR is helpful to optimize the timing of sPCI.Clinical Trial RegistrationClinicalTrials.gov:NCT02241291Clinical PerspectiveWhat is new?This was the first study to investigate the association between non-target-vessel (non-TV) Quantitative Flow Ratio (QFR) and non-TV events occurring prior to planned staged percutaneous coronary intervention (PCI) among acute coronary syndrome (ACS) patients with multivessel disease, to derive first conceptual knowledge, whether QFR could be helpful to optimize the timing of staged PCI.Among 1093 ACS patients and 1262 non-TV scheduled to undergo out-of-hospital staged PCI within a median of 28 days from index PCI, QFR did not emerge as an independent predictor of non-TV events occurring prior to planned staged PCI.What are the clinical implications?Among ACS patients in whom, according to the operator’s judgment, it is feasible to perform out-of-hospital staged PCI within a median of 1 month from index PCI, this study does not provide conceptual evidence, that QFR could be helpful to optimize the timing of staged PCI (i.e. to schedule staged PCI earlier in case of lower QFR).Grapical AbstractStudy design (left) and primary endpoint results (right). For non-linear QFR, hazard ratios were calculated using the reference hazard corresponding to QFR=0.80 (grey dashed line) from a Cox proportional hazards model with penalized splines. ACS = acute coronary syndrome, CI = confidence interval, DS% = diameter stenosis, HR = hazard ratio, non-TV-MI = non-target-vessel myocardial infarction, non-TV-PCI = non-target-vessel percutaneous coronary intervention, PCI = percutaneous coronary intervention, QFR = Quantitative Flow Ratio, 1°EP = primary endpoint.

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“…[4] Moreover, acute-phase QFR values are highly consistent with nonacute phase values. [5] Further studies have demonstrated that postoperative QFR can predict outcomes in patients with ST-elevation myocardial infarction (STEMI). [6] Patients with diabetes mellitus (DM) have decreased coronary ow reserve and elevated microvascular resistance index.…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Impact of Diabetes Status and Postoperative Murray law‐based Quantitative Flow Ratio Value in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Guo,

Chen,

Zhong

et al. 2023

Preprint

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Introduction: Patients with diabetes mellitus (DM) and acute myocardial infarction (AMI) have a higher incidence of microcirculatory disturbance, which may affect the accuracy of Murray law-based quantitative flow ratio (µQFR) values. Whether diabetic status affects the relationship between postoperative µQFR values and prognosis in patients with AMI remains unclear. Methods This was a retrospective analysis. Patients with AMI who underwent percutaneous coronary intervention (PCI) were included and divided into two groups based on the cut-off value for post-PCI µQFR. The primary endpoint was vessel-oriented composite events (VOCE), defined as the composite of vessel-related cardiovascular death, vessel-related MI, and target vessel revascularization (TVR). Results A total of 649 patients with AMI and 937 coronary arteries were included. The optimal µQFR cut-off value was 0.89. Compared to lower postoperative µQFR values (µQFR < 0.89), higher postoperative µQFR values (µQFR ≥ 0.89) were associated with reduced VOCE incidence (HR = 0.54; 95%CI: 0.37–0.78, P < 0.001), regardless of diabetic status (HR = 0.54; 95% CI: 0.31–0.92, P = 0.023 in DM; HR = 0.56; 95%CI: 0.33–0.93, P = 0.026 in non-DM; interaction P value = 0.936). Additionally, higher postoperative QFR values (µQFR ≥ 0.89) were associated with significantly lower rates of cardiac death and TVR, but not MI, compared to lower postoperative µQFR values (µQFR < 0.89). These findings were consistent in diabetic and nondiabetic patients. Conclusion Regardless of diabetes status, postoperative µQFR measurement was related to VOCE incidence in AMI, with lower postoperative µQFR values indicating a poorer prognosis.

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Improved Nonculprit Stenosis Assessment in Patients With ST-Segment Elevation Myocardial Infarction Using Quantitative Flow Ratio

Cited by 10 publications

References 5 publications

Quantitative Flow Ratio to Predict Non–Target‐Vessel Events Before Planned Staged Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome

Quantitative Flow Ratio to Predict Non–Target‐Vessel Events Before Planned Staged Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome

Quantitative Flow Ratio to Predict Non-Target-Vessel Events Prior to Planned Staged PCI in ACS Patients

The Prognostic Impact of Diabetes Status and Postoperative Murray law‐based Quantitative Flow Ratio Value in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

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