Key result
QFR demonstrates ~0.96 AUC versus NHPR for detecting significant non-culprit lesions in NSTE-ACS.
Why the study?
Quantitative Flow Ratio is a new angiography-based tool to evaluate intermediate coronary lesions, but its diagnostic performance in NSTE-ACS compared with non-hyperaemic pressure ratios required assessment.
Does Quantitative Flow Ratio (QFR) accurately detect functionally significant non-culprit lesions compared to non-hyperaemic pressure ratios (NHPRs) in patients with NSTE-ACS?
Observational (n=48)
Single-blind
No
Does Quantitative Flow Ratio (QFR) accurately detect functionally significant non-culprit lesions compared to non-hyperaemic pressure ratios (NHPRs) in patients with NSTE-ACS?
Effect estimate: AUC 0.962 (95% CI 0.914-1.00)
p-value: p=<0.001
QFR demonstrates high diagnostic accuracy and classification agreement compared to invasive non-hyperemic pressure ratios for assessing intermediate non-culprit lesions in NSTE-ACS, potentially allowing safe deferral of invasive physiological assessment.
QFR may aid non-culprit lesion assessment in NSTE-ACS; leaves open replacement of NHPRs pending randomized validation.
Purpose Quantitative Flow Ratio (QFR) is a new angiography-based coronary physiology tool aimed to evaluate functional relevance of intermediate coronary lesions. Aim of the study is to assess diagnostic performance of QFR in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) in comparison to currently used non-hyperaemic pressure ratios (NHPRs). Methods In this prospective, single-centre study, coronary physiology of intermediate coronary stenoses of non-culprit vessels in patients presenting with NSTE-ACS was evaluated using NHPRs (iFR, DFR or RFR). Subsequently, QFR was computed offline by a QFR analyst blinded to the NHPR results. Diagnostic performance of QFR was assessed in comparison to NHPRs as reference standard. Results A total of 60 vessels with intermediate coronary stenoses was investigated. The NHPRs were used as follows: RFR 38%, DFR 47% and iFR 15% of the cases. The NHPR result was positive, showing significant lesion, in 19 cases. A significant correlation was found between NHPR and QFR (r = 0.84, p < 0.001). Classification agreement of the two methods (95%) and diagnostic performance of QFR in comparison to NHPR (AUC: 0.962 [0.914–1.00]) were both high. Sensitivity, specificity, positive and negative predictive value of QFR in comparison to NHPR were 84.2%, 100%, 100% and 93.2% respectively. Conclusion QFR has high diagnostic performance in detecting functionally significant lesions of non-culprit arteries in patients with NSTE-ACS and multivessel disease. Due to its high negative predictive value, it can be used to safely avoid unnecessary invasive physiological assessment of these lesions.
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Liontou et al. (2023) conducted an observational in Non-ST elevation acute coronary syndromes (NSTE-ACS) (n=48). Quantitative Flow Ratio (QFR) vs. Non-hyperaemic pressure ratios (NHPRs: iFR, DFR, RFR) was evaluated on Diagnostic performance of QFR in comparison to NHPRs (AUC 0.962, 95% CI 0.914-1.00, p=<0.001). Quantitative Flow Ratio demonstrated high diagnostic performance for detecting functionally significant non-culprit lesions in NSTE-ACS patients compared to non-hyperemic pressure ratios (AUC 0.962).
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