Untreated nonculprit lesions with a QFR ≤0.80 in STEMI patients were associated with a higher 5-year rate of cardiac events compared to QFR >0.80 (62.9% vs 12.5%; HR 7.33; 95% CI 4.54-11.83; P<0.001).
Cohort (n=617)
Blinded assessors
Yes
Does a QFR ≤0.80 predict adverse clinical outcomes compared to QFR >0.80 in untreated nontarget vessels of STEMI patients undergoing angiography-guided revascularization?
QFR ≤0.80 in untreated nonculprit lesions is a strong independent predictor of 5-year adverse events in STEMI patients, suggesting incremental prognostic value over standard angiography.
Effect estimate: HR 7.33 (95% CI 4.54-11.83)
Absolute Event Rate: 62.9% vs 12.5%
p-value: p=<0.001
Background In ST‐segment–elevation myocardial infarction, angiography‐based complete revascularization is superior to culprit‐lesion‐only percutaneous coronary intervention. Quantitative flow ratio (QFR) is a novel, noninvasive, vasodilator‐free method used to assess the hemodynamic significance of coronary stenoses. We aimed to investigate the incremental value of QFR over angiography in nonculprit lesions in patients with ST‐segment–elevation myocardial infarction undergoing angiography‐guided complete revascularization. Methods and Results This was a retrospective post hoc QFR analysis of untreated nontarget vessels (any degree of diameter stenosis DS) from the randomized multicenter COMFORTABLE AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST‐Elevation Myocardial Infarction) trial by assessors blinded for clinical outcomes. The primary end point was cardiac death, spontaneous nontarget vessel myocardial infarction, and clinically indicated nontarget vessel revascularization (ie, ≥70% DS by 2‐dimensional quantitative coronary angiography or ≥50% DS and ischemia) at 5 years. Of 1161 patients with ST‐segment–elevation myocardial infarction, 946 vessels in 617 patients were analyzable by QFR. At 5 years, the rate of the primary end point was significantly higher in patients with QFR ≤0.80 (n=35 patients, n=36 vessels) versus QFR >0.80 (n=582 patients, n=910 vessels) (62.9% versus 12.5%, respectively; hazard ratio HR, 7.33 95% CI, 4.54–11.83, P 30% DS by 3‐dimensional quantitative coronary angiography. Conclusions Our study suggests incremental value of QFR over angiography‐guided percutaneous coronary intervention for nonculprit lesions among patients with ST‐segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention.
Bär et al. (Mon,) conducted a cohort in ST-segment-elevation myocardial infarction (n=617). Quantitative flow ratio (QFR) ≤0.80 vs. QFR >0.80 was evaluated on Cardiac death, spontaneous nontarget vessel myocardial infarction, and clinically indicated nontarget vessel revascularization at 5 years (HR 7.33, 95% CI 4.54-11.83, p=<0.001). Untreated nonculprit lesions with a QFR ≤0.80 in STEMI patients were associated with a higher 5-year rate of cardiac events compared to QFR >0.80 (62.9% vs 12.5%; HR 7.33; 95% CI 4.54-11.83; P<0.001).
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