Quantitative flow ratio for immediate assessment of nonculprit lesions in patients with ST-segment elevation myocardial infarction-An iSTEMI substudy

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  • Martin Sejr-Hansen
  • Jelmer Westra
  • Troels Thim
  • Evald Høj Christiansen
  • ,
  • Ashkan Eftekhari
  • Steen Dalby Kristensen
  • Lars Jakobsen
  • ,
  • Matthias Götberg, Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden. Electronic address: pontus.andell@med.lu.se.
  • ,
  • Ole Frøbert, Department of Cardiology, Universitetssjukhuset Örebro, Örebro, Sweden.
  • ,
  • Nina W van der Hoeven, Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
  • ,
  • Niels Ramsing Holm
  • Michael Maeng

OBJECTIVES: We evaluated the diagnostic performance of quantitative flow ratio (QFR) assessment of nonculprit lesions (NCLs) based on acute setting angiograms obtained in patients with ST-segment elevation myocardial infarction (STEMI) with QFR, fractional flow reserve (FFR), and instantaneous wave-free ratio (iFR) in the staged setting as reference.

BACKGROUND: QFR is an angiography-based approach for the functional evaluation of coronary artery lesions.

METHODS: This was a post-hoc analysis of the iSTEMI study. NCLs were assessed with iFR in the acute setting and with iFR and FFR at staged (median 13 days) follow-up. Acute and staged QFR values were computed in a core laboratory based on the coronary angiography recordings. Diagnostic cut-off values were ≤0.80 for QFR and FFR, and ≤0.89 for iFR.

RESULTS: Staged iFR and FFR data were available for 146 NCLs in 112 patients in the iSTEMI study. Among these, QFR analysis was feasible in 103 (71%) lesions assessed in the acute setting with a mean QFR value of 0.82 (IQR: 0.73-0.91). Staged QFR, FFR, and iFR were 0.80 (IQR: 0.70-0.90), 0.81 (IQR: 0.71-0.88), and 0.91 (IQR: 0.87-0.96), respectively. Classification agreement of acute and staged QFR was 93% (95%Cl: 87-99). The classification agreement of acute QFR was 84% (95%CI: 76-90) using staged FFR as reference and 74% (95%CI: 65-83) using staged iFR as reference.

CONCLUSIONS: Acute QFR showed a very good diagnostic performance with staged QFR as reference, a good diagnostic performance with staged FFR as reference, and a moderate diagnostic performance with staged iFR as reference.

Original languageEnglish
JournalCatheterization and Cardiovascular Interventions
Publication statusE-pub ahead of print - 25 Mar 2019

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