Key result
Low quantitative flow ratio in nonculprit and post-PCI culprit vessels independently predicted major adverse cardiovascular events at 2 years (adjusted OR 3.78 and 3.60, respectively; both P<0.001).
Why the study?
Although QFR was introduced and validated for fast hemodynamic lesion assessment, its prognostic role across both postinterventional culprit and nonculprit vessels in ACS patients remained to be defined.
Does pancoronary Quantitative Flow Ratio (QFR) assessment predict major adverse cardiovascular events in patients undergoing PCI for acute coronary syndrome?
Cohort (n=792)
Blinded to clinical outcomes
Does pancoronary Quantitative Flow Ratio (QFR) assessment predict major adverse cardiovascular events in patients undergoing PCI for acute coronary syndrome?
Pancoronary QFR assessment of both culprit and nonculprit vessels independently predicts 2-year major adverse cardiovascular events in patients undergoing PCI for ACS.
Answers are grounded in this paper and cite their sources.
Pancoronary QFR assessment was associated with MACE after ACS; hypothesis-generating for risk stratification and management, pending prospective trials.
Background: Quantitative flow ratio (QFR) has been introduced as a novel angiography-based modality for fast hemodynamic assessment of coronary artery lesions and validated against fractional flow reserve. This study sought to define the prognostic role of pancoronary QFR assessment in patients with acute coronary syndrome (ACS) including postinterventional culprit and nonculprit vessels. Methods: In a total of 792 patients with ACS (48.6% ST-segment–elevation ACS and 51.4% non–ST-segment–elevation ACS), QFR analyses of postinterventional culprit (n=792 vessels) and nonculprit vessels (n=1231 vessels) were post hoc performed by investigators blinded to clinical outcomes. The follow-up comprised of major adverse cardiovascular events, including all-cause mortality, nonfatal myocardial infarction, and ischemia-driven coronary revascularization within 2 years after the index ACS event. Results: Major adverse cardiovascular events as composite end point occurred in 99 patients (12.5%). QFR with an optimal cutoff value of 0.89 for postinterventional culprit vessels and 0.85 for nonculprit vessels emerged as independent predictor of major adverse cardiovascular events after ACS (nonculprit arteries: adjusted odds ratio, 3.78 [95% CI, 2.21–6.45], P <0.001 and postpercutaneous coronary intervention culprit arteries: adjusted odds ratio, 3.60 [95% CI, 2.09–6.20], P <0.001). Conclusions: The present study for the first time demonstrates the prognostic implications of a pancoronary angiography-based functional lesion assessment in patients with ACS. Hence, QFR offers a novel tool to advance risk stratification and guide therapeutic management after ACS.
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A 2021 study conducted a cohort in Acute coronary syndrome (n=792). Quantitative flow ratio (QFR) ≤0.85 in nonculprit vessels vs. QFR >0.85 in nonculprit vessels was evaluated on Major adverse cardiovascular events (all-cause mortality, nonfatal myocardial infarction, and ischemia-driven coronary revascularization) (OR 3.78, 95% CI 2.21-6.45, p=<0.001). Low quantitative flow ratio in nonculprit and post-PCI culprit vessels independently predicted major adverse cardiovascular events at 2 years (adjusted OR 3.78 and 3.60, respectively; both P<0.001).
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