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Clinical Implication of Quantitative Flow Ratio After Percutaneous Coronary Intervention for 3-Vessel Disease
Norihiro Kogame1, Kuniaki Takahashi2, Mariusz Tomaniak3
1Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Toho University medical center Ohashi hospital, Tokyo, Japan. Electronic address: https://twitter.com/KogameNorihiro.
Insights
A post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) of 0.91 or higher is associated with better clinical outcomes in patients with de novo 3-vessel disease (3VD). Achieving this QFR threshold is a target for improving patient results after PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- The clinical significance of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients with de novo 3-vessel disease (3VD) undergoing contemporary PCI remains unclear.
- State-of-the-art PCI techniques have advanced, but optimal functional assessment post-procedure for 3VD is still under investigation.
Purpose of the Study:
- To evaluate the impact of post-PCI QFR on clinical outcomes in patients with de novo 3VD treated with contemporary PCI.
- To determine the optimal QFR cutoff value for predicting adverse events after PCI in this patient cohort.
Main Methods:
- Retrospective analysis of vessels treated with PCI in the SYNTAX II trial.
- Calculation of post-PCI QFR for all analyzable vessels.
- Primary endpoint: vessel-oriented composite endpoint (VOCE) at 2 years (vessel-related death, myocardial infarction, or revascularization).
- Receiver-operating characteristic (ROC) curve analysis to identify the optimal QFR cutoff for VOCE prediction.
Main Results:
- Post-PCI QFR was analyzed in 771 out of 968 treated vessels (79.6%).
- The mean post-PCI QFR was 0.91 ± 0.07. The optimal QFR cutoff for predicting 2-year VOCE was 0.91 (AUC: 0.702).
- Patients with post-PCI QFR < 0.91 had a significantly higher incidence of VOCE (12.0%) compared to those with QFR ≥ 0.91 (3.7%) at 2 years (HR: 3.37, p < 0.001).
Conclusions:
- Higher post-PCI QFR values are linked to improved vessel-related clinical outcomes in de novo 3VD treated with contemporary PCI.
- A post-PCI QFR of ≥ 0.91 should be a treatment target for de novo 3VD to enhance clinical results.
- Prospective trials are needed to confirm these findings.
Objectives:
The aim of this study was to investigate the impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) on clinical outcomes in patients with de novo 3-vessel disease (3VD) treated with contemporary PCI.
Background:
The clinical impact of post-PCI QFR in patients treated with state-of-the-art PCI for de novo 3VD is undetermined.
Methods:
All vessels treated in the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) II trial were retrospectively screened and analyzed for post-PCI QFR. The primary endpoint of this substudy was vessel-oriented composite endpoint (VOCE) at 2 years, defined as the composite of vessel-related cardiac death, vessel-related myocardial infarction, and target vessel revascularization. The receiver-operating characteristic curve was used to calculate the optimal cutoff value of post-PCI QFR for predicting 2-year VOCE. All the analyzable vessels were stratified on the basis of the optimal cutoff value.
Results:
A total of 968 vessels treated with PCI were screened. Post-PCI QFR was analyzable in 771 (79.6%) vessels. A total of 52 (6.7%) VOCEs occurred at 2 years. The mean value of post-PCI QFR was 0.91 ± 0.07. The diagnostic performance of post-PCI QFR to predict 2-year VOCE was moderate (area under the curve: 0.702; 95% confidence interval: 0.633 to 0.772), with the optimal cutoff value of post-PCI QFR for predicting 2-year VOCE 0.91 (sensitivity 0.652, specificity 0.635). The incidence of 2-year VOCE in the vessels with post-PCI QFR <0.91 (n = 284) was significantly higher compared with vessels with post-PCI QFR ≥0.91 (n = 487) (12.0% vs. 3.7%; hazard ratio: 3.37; 95% confidence interval: 1.91 to 5.97; p < 0.001).
Conclusions:
A higher post-PCI QFR value is associated with improved vessel-related clinical outcomes in state-of-the art PCI practice for de novo 3VD. Achieving a post-PCI QFR value ≥0.91 in all treated vessels should be a target when treating de novo 3VD. These findings require confirmation in future prospective trials.
