Key result
Prior myocardial infarction was significantly associated with an increased classification discrepancy between quantitative flow ratio and fractional flow reserve (OR 3.16).
Why the study?
The authors sought to explore the influence of diabetes mellitus on quantitative flow ratio performance and identify predictors of discrepancies between quantitative flow ratio and fractional flow reserve.
Does diabetes mellitus or prior myocardial infarction affect the diagnostic performance and discrepancy between quantitative flow ratio (QFR) and fractional flow reserve (FFR) in patients with intermediate coronary stenoses?
Observational (n=224)
Single-blind
No
Does diabetes mellitus or prior myocardial infarction affect the diagnostic performance and discrepancy between quantitative flow ratio (QFR) and fractional flow reserve (FFR) in patients with intermediate coronary stenoses?
Odds Ratio: 3.16 (95% CI 1.29–7.75)
p-value: p=.01
Quantitative flow ratio (QFR) maintains high diagnostic accuracy compared to FFR regardless of diabetes status, though prior myocardial infarction significantly increases the risk of QFR-FFR classification discrepancy.
BACKGROUND: Quantitative flow ratio is a novel technology for the functional assessment of intermediate coronary stenoses. The authors sought to explore the influence of diabetes mellitus on the application of quantitative flow ratio and predictors of discrepancies between quantitative flow ratio and fractional flow reserve. METHODS: Quantitative flow ratio was calculated in 224 patients (317 vessels) who underwent fractional flow reserve measurement by professional technicians blinded to fractional flow reserve value. Patients were divided into the diabetes mellitus group and the non-diabetes mellitus group. The diagnostic performance of quantitative flow ratio was assessed using fractional flow reserve as a reference. RESULTS: Good correlation and agreement between quantitative flow ratio and fractional flow reserve can be found in the diabetes mellitus group (r = 0.834, P <.001; mean difference: 0.007 ± 0.108). Prior myocardial infarction showed a statistically significant association with increased classification discrepancy between quantitative flow ratio and fractional flow reserve (odds ratio 3.16 (95% confidence interval: 1.29-7.75), P =.01). The area under the receiver-operating characteristic curve of quantitative flow ratio showed no significant difference in diabetes mellitus and non-diabetes mellitus groups, hemoglobin A1c ≥ 7% and hemoglobin A1c < 7% groups, diabetic duration ≥ 10 years and diabetic duration < 10 years groups (area under receiver-operating characteristic curve: 0.90 (95% confidence interval: 0.84-0.94) vs. 0.92 (95% confidence interval: 0.87-0.96), P =.54; 0.89 (95% confidence interval: 0.81-0.95) vs. 0.92 (95% confidence interval: 0.81-0.97), P =.65; 0.88 (95% confidence interval: 0.79-0.94) vs. 0.89 (95% confidence interval: 0.79-0.96), P =.83; respectively). CONCLUSIONS: Clinical application of quantitative flow ratio is not limited to diabetic patients. The relationship between prior myocardial infarction and quantitative flow ratio needs to be further developed.
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Tianhui Dong (2023) conducted an observational in Intermediate coronary stenoses (n=224). Prior myocardial infarction vs. No prior myocardial infarction was evaluated on Classification discrepancy between quantitative flow ratio and fractional flow reserve (OR 3.16, 95% CI 1.29-7.75, p=.01). Prior myocardial infarction was significantly associated with an increased classification discrepancy between quantitative flow ratio and fractional flow reserve (OR 3.16).
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