Key result
QFR demonstrates high diagnostic accuracy of 0.91 AUC for non-culprit lesions during primary PCI.
Why the study?
Functional assessment of non-culprit lesions in patients presenting with STEMI and multivessel disease constitutes an unmet need.
Does QFR accurately assess the functional severity of non-culprit lesions during primary PCI in patients with STEMI compared to FFR?
Observational (n=82)
Blinded
Yes
Does QFR accurately assess the functional severity of non-culprit lesions during primary PCI in patients with STEMI compared to FFR?
Effect estimate: AUC 0.91 (95% CI 0.85-0.97)
Absolute Event Rate: 0.91% vs 0.94%
p-value: p=0.5
QFR provides high diagnostic accuracy for assessing the functional significance of non-culprit lesions during primary PCI in STEMI patients, potentially reducing the need for staged FFR procedures.
Supports QFR for non-culprit lesions in STEMI primary PCI; hypothesis-generating, needs prospective validation.
AIMS: Functional assessment of non-culprit lesions (NCL) in patients presenting with ST-elevation myocardial infarction (STEMI) and multivessel disease constitutes an unmet need. This study aimed to evaluate the diagnostic accuracy of quantitative flow ratio (QFR) in the functional assessment of NCL during the acute phase of STEMI. METHODS AND RESULTS: This was a retrospective, observational, multicentre study including patients with STEMI and staged fractional flow reserve (FFR) assessment of NCL. QFR in NCL was calculated from the coronary angiogram acquired during primary PCI in a blinded fashion with respect to FFR. The diagnostic value of QFR in the STEMI population was compared with a propensity score-matched population of stable angina patients. Eighty-two patients (91 NCL) were included. Target lesions were of both angiographic and functional (mean FFR 0.82±0.09) intermediate severity. The diagnostic performance of QFR was high (AUC 0.91 [95% CI: 0.85-0.97]) and similar to that observed in the matched control population (AUC 0.91 vs 0.94, p=0.5). The diagnostic accuracy of QFR was very high (>95%) in those vessels (61.5%) with QFR values out of a ROC-defined "grey zone" (0.75-0.85). A hybrid FFR/QFR approach (FFR only when QFR is in the grey zone) would adequately classify 96.7% of NCL, avoiding 58.5% of repeat diagnostic procedures. CONCLUSIONS: QFR has a good diagnostic accuracy in assessing the functional relevance of NCL during primary PCI, similar to the accuracy observed in stable patients.
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Lauri et al. (2020) conducted an observational in ST-elevation myocardial infarction (STEMI) and multivessel disease (n=82). Quantitative flow ratio (QFR) vs. Fractional flow reserve (FFR) / stable angina patients was evaluated on Diagnostic accuracy of QFR in the functional assessment of non-culprit lesions (AUC 0.91, 95% CI 0.85-0.97, p=0.5). Quantitative flow ratio (QFR) demonstrated high diagnostic accuracy for assessing non-culprit lesions during primary PCI (AUC 0.91; 95% CI 0.85-0.97), similar to stable angina patients (P=0.5).
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