Prognostic Impact of Pancoronary Quantitative Flow Ratio Assessment in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes

Abstract

Background: Quantitative flow ratio (QFR) has been introduced as a novel angiography-based modality for fast hemodynamic assessment of coronary artery lesions and validated against fractional flow reserve. This study sought to define the prognostic role of pancoronary QFR assessment in patients with acute coronary syndrome (ACS) including postinterventional culprit and nonculprit vessels. Methods: In a total of 792 patients with ACS (48.6% ST-segment–elevation ACS and 51.4% non–ST-segment–elevation ACS), QFR analyses of postinterventional culprit (n=792 vessels) and nonculprit vessels (n=1231 vessels) were post hoc performed by investigators blinded to clinical outcomes. The follow-up comprised of major adverse cardiovascular events, including all-cause mortality, nonfatal myocardial infarction, and ischemia-driven coronary revascularization within 2 years after the index ACS event. Results: Major adverse cardiovascular events as composite end point occurred in 99 patients (12.5%). QFR with an optimal cutoff value of 0.89 for postinterventional culprit vessels and 0.85 for nonculprit vessels emerged as independent predictor of major adverse cardiovascular events after ACS (nonculprit arteries: adjusted odds ratio, 3.78 [95% CI, 2.21–6.45], P <0.001 and postpercutaneous coronary intervention culprit arteries: adjusted odds ratio, 3.60 [95% CI, 2.09–6.20], P <0.001). Conclusions: The present study for the first time demonstrates the prognostic implications of a pancoronary angiography-based functional lesion assessment in patients with ACS. Hence, QFR offers a novel tool to advance risk stratification and guide therapeutic management after ACS.

Clinical Relevance of Impaired Physiological Assessment After Percutaneous Coronary Intervention: A Meta-analysis

“…More recently, new modalities, such as iFR and QFR, have been investigated to provide additional data about the importance of post-PCI coronary physiology in relation to long-term outcomes. [16][17][18][19]22,23 The current meta-analysis pooled the data of the currently available studies on the value of post-PCI physiological assessment using FFR, iFR, and QFR. This is the first meta-analysis providing data about several physiological assessment modalities, including iFR and QFR.…”

Angiographic quantitative flow ratio in acute coronary syndrome: beyond a tool to define ischemia-causing stenosis—a literature review

“…The recently published studies focusing on the prognostic value of QFR in patients with ACS are presented in Table 4 (16,17,32,(50)(51)(52)(53)(54)(55)(56)(57). A study by Choi et al (32) enrolling 452 all-comer patients with CAD (25.9% with ACS) demonstrated that vessels with QFR≤0.80 showed a significantly higher risk of vessel-related adverse events Another important clinical scenario to perform physiological assessment is in the catheterization laboratory after the index procedure.…”

“…The recently published studies focusing on the prognostic value of QFR in patients with ACS are presented in Table 4 ( 16 , 17 , 32 , 50 - 57 ). A study by Choi et al ( 32 ) enrolling 452 all-comer patients with CAD (25.9% with ACS) demonstrated that vessels with QFR ≤0.80 showed a significantly higher risk of vessel-related adverse events compared to those with QFR >0.80 at 2-year [hazard ratio (HR) 4.650, 95% CI: 1.254–17.240, P=0.022].…”

“…Under these circumstances, it appears unnecessary for the functional assessment of the culprit lesion before interventional treatment, along with the evidence showing that hemodynamic severity of the infarcted-related artery (IRA) evaluated by FFR or QFR at the acute phase of myocardial infarction (MI) may be underestimated due to the presence of microvascular dysfunction ( 15 , 16 ). However, for culprit vessels after stent implantation in ACS, recent studies have revealed the prognostic value of QFR in predicting long-term adverse cardiac outcomes ( 16 , 17 ). In addition, around half of acute myocardial infarction (AMI) patients have multivessel disease (MVD), with angiographically significant stenoses located in non-culprit vessels ( 18 ).…”

Triglyceride-glucose index is associated with quantitative flow ratio in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention

“…Physiological assessment after PCI, such as quantitative flow ratio (QFR) analysis, can be used as an effective means to quantify residual coronary ischemia (4)(5)(6). Studies have confirmed that poor post-PCI QFR is associated with a poorer prognosis, but the susceptibility factors affecting poor postoperative QFR remain unclear (7)(8)(9). Therefore, identifying risk factors for poor postoperative QFR has important clinical significance for reducing the risk of coronary residual ischemia.…”