Key result
QFR, Pd/Pa, and DFR demonstrated high diagnostic accuracy (AUC 0.964, 0.909, and 0.946, respectively; all p=0.0001) compared to FFR for assessing non-culprit lesions in NSTEMI patients.
Why the study?
NHPR and angiography-based indexes were developed to overcome FFR limitations, prompting evaluation of their correlation with FFR in non-culprit lesions of NSTEMI patients.
Do QFR, Pd/Pa, and DFR provide equivalent diagnostic accuracy to FFR for assessing non-culprit lesions in NSTEMI patients?
Observational (n=116)
Do QFR, Pd/Pa, and DFR provide equivalent diagnostic accuracy to FFR for assessing non-culprit lesions in NSTEMI patients?
Effect estimate: AUC 0.964 (95% CI 0.91-0.98)
p-value: p=0.0001
QFR, Pd/Pa, and DFR show equivalent diagnostic accuracy to the gold standard FFR for identifying flow-limiting non-culprit lesions in NSTEMI patients.
May support adenosine-free assessment of non-culprit lesions in NSTEMI; hypothesis-generating and requires prospective validation.
OBJECTIVES: To investigate the correlation between quantitative flow ratio (QFR), Pd/Pa, diastolic hyperemia-free ratio (DFR) and fractional flow reserve (FFR, gold standard) in non-culprit lesion (NCL) of patients with non ST-segment elevation myocardial infarction (NSTEMI). BACKGROUND: The non-hyperemic pressure ratio (NHPR) and the angiography-based indexes have been developed to overcome the limitation of the use of the FFR. METHODS: Between January and December 2019, 184 NCL from 116 NSTEMI patients underwent physiologic assessment and were included in the study. NCLs were investigated with QFR, Pd/Pa, DFR, and FFR. Mean values of QFR, Pd/Pa, DFR and FFR were 0.85 ± 0.10, 0.92 ± 0.07, 0.93 ± 0.05 and 0.84 ± 0.07, respectively. RESULTS: DFR and FFR showed a good correlation (r = 0.76). Bland and Altman plot showed a mean difference of 0.080. DFR Diagnostic accuracy was 88%. The area under the ROC curve (AUC) for DFR was 0.946 (95%CI 0.90-0.97, p = .0001). Similar findings were reported for Pd/Pa (r = 0.73; mean difference 0.095, diagnostic accuracy 84%, AUC 0.909 [95%CI 0.85-0.94, p = .0001]) and QFR (r = 0.68; mean difference 0.01; diagnostic accuracy 88%, AUC 0.964 [95% CI 0.91-0.98, p = .0001]). FFR, QFR, Pd/Pa and DFR identified 31%, 32%, 30% and 32% potentially flow-limiting lesions, respectively. CONCLUSIONS: In NSTEMI patients, QFR, Pd/Pa and DFR showed equivalence as compared to gold standard FFR in the discrimination of non-culprit lesions requiring revascularization.
No takes yet. Share an insight, caveat, or question.
Tebaldi et al. (2020) conducted an observational in Non ST-segment elevation myocardial infarction (NSTEMI) (n=116). Quantitative flow ratio (QFR), Pd/Pa, and diastolic hyperemia-free ratio (DFR) vs. Fractional flow reserve (FFR) was evaluated on Diagnostic accuracy (Area under the ROC curve) of QFR compared to FFR (AUC 0.964, 95% CI 0.91-0.98, p=0.0001). QFR, Pd/Pa, and DFR demonstrated high diagnostic accuracy (AUC 0.964, 0.909, and 0.946, respectively; all p=0.0001) compared to FFR for assessing non-culprit lesions in NSTEMI patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: