Key result
Higher postoperative µQFR linked to ~46% lower VOCE risk regardless of diabetic status.
Why the study?
Patients with diabetes and acute myocardial infarction have higher microcirculatory disturbance, which may affect the accuracy of postoperative Murray law-based quantitative flow ratio values and their prognostic significance.
Does higher postoperative µQFR (≥ 0.89) reduce vessel-oriented composite events in patients with AMI undergoing PCI compared to lower µQFR (< 0.89)?
Cohort (n=649)
No
Does higher postoperative µQFR (≥ 0.89) reduce vessel-oriented composite events in patients with AMI undergoing PCI compared to lower µQFR (< 0.89)?
Hazard Ratio: 0.54 (95% CI 0.37–0.78)
p-value: p=<0.001
Post-PCI µQFR measurement is a useful prognostic tool in AMI patients, with values ≥0.89 indicating better clinical outcomes independent of diabetes status.
Post-PCI µQFR ≥0.89 was associated with lower VOCE risk regardless of diabetes; hypothesis-generating and requires prospective confirmation before practice change.
Introduction: Patients with diabetes mellitus (DM) and acute myocardial infarction (AMI) have a higher incidence of microcirculatory disturbance, which may affect the accuracy of Murray law-based quantitative flow ratio (µQFR) values. Whether diabetic status affects the relationship between postoperative µQFR values and prognosis in patients with AMI remains unclear. Methods This was a retrospective analysis. Patients with AMI who underwent percutaneous coronary intervention (PCI) were included and divided into two groups based on the cut-off value for post-PCI µQFR. The primary endpoint was vessel-oriented composite events (VOCE), defined as the composite of vessel-related cardiovascular death, vessel-related MI, and target vessel revascularization (TVR). Results A total of 649 patients with AMI and 937 coronary arteries were included. The optimal µQFR cut-off value was 0.89. Compared to lower postoperative µQFR values (µQFR < 0.89), higher postoperative µQFR values (µQFR ≥ 0.89) were associated with reduced VOCE incidence (HR = 0.54; 95%CI: 0.37–0.78, P < 0.001), regardless of diabetic status (HR = 0.54; 95% CI: 0.31–0.92, P = 0.023 in DM; HR = 0.56; 95%CI: 0.33–0.93, P = 0.026 in non-DM; interaction P value = 0.936). Additionally, higher postoperative QFR values (µQFR ≥ 0.89) were associated with significantly lower rates of cardiac death and TVR, but not MI, compared to lower postoperative µQFR values (µQFR < 0.89). These findings were consistent in diabetic and nondiabetic patients. Conclusion Regardless of diabetes status, postoperative µQFR measurement was related to VOCE incidence in AMI, with lower postoperative µQFR values indicating a poorer prognosis.
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Guo et al. (2023) conducted a cohort in Acute Myocardial Infarction (AMI) (n=649). Postoperative µQFR ≥ 0.89 vs. Postoperative µQFR < 0.89 was evaluated on Vessel-oriented composite events (VOCE), defined as the composite of vessel-related cardiovascular death, vessel-related MI, and target vessel revascularization (TVR) (HR 0.54, 95% CI 0.37-0.78, p=<0.001). Higher postoperative µQFR values (≥ 0.89) were associated with a significantly reduced incidence of vessel-oriented composite events compared to lower values (HR 0.54), regardless of diabetic status.
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