Quantitative Flow Ratio to Predict Nontarget Vessel-Related Events at 5 Years in Patients With ST-Segment-Elevation...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Complete revascularization in ST-elevation myocardial infarction (STEMI) is superior to culprit-lesion-only intervention.
• Quantitative flow ratio (QFR) is a noninvasive method to assess coronary stenosis significance.
• The incremental value of QFR in nonculprit lesions in STEMI patients remains to be fully elucidated.

Purpose of the Study:

• To investigate the added value of QFR over standard angiography for assessing nonculprit lesions in STEMI patients.
• To determine if QFR can predict long-term adverse cardiac events in this population.
• To compare QFR's predictive performance against angiographic diameter stenosis (DS).

Main Methods:

• Retrospective analysis of the COMFORTABLE AMI trial data.
• QFR analysis of untreated nontarget vessels in STEMI patients.
• Primary endpoint: cardiac death, myocardial infarction, or revascularization at 5 years.

Main Results:

• QFR ≤0.80 was associated with a significantly higher rate of the primary endpoint (62.9% vs 12.5%, HR 7.33, P<0.001).
• This difference was driven by increased non-target vessel myocardial infarction and revascularization.
• QFR ≤0.80, but not ≥50% DS by angiography, independently predicted the primary endpoint.

Conclusions:

• QFR provides incremental prognostic value over angiography for nonculprit lesions in STEMI patients undergoing primary PCI.
• QFR assessment of nonculprit lesions can refine risk stratification and guide treatment decisions.
• This supports the utility of QFR in optimizing complete revascularization strategies in STEMI.