Related Experiment Video
Updated: Nov 8, 2025
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Quantitative Flow Ratio to Predict Nontarget Vessel-Related Events at 5 Years in Patients With ST-Segment-Elevation
Sarah Bär1, Raminta Kavaliauskaite1, Yasushi Ueki1
1Department of Cardiology Bern University Hospital Inselspital Bern Switzerland.
Insights
Quantitative flow ratio (QFR) improves nonculprit lesion assessment in ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention. QFR ≤0.80 independently predicted adverse events, offering superior prognostic value over traditional angiography.
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.
Abstract:
Background In ST-segment-elevation myocardial infarction, angiography-based complete revascularization is superior to culprit-lesion-only percutaneous coronary intervention. Quantitative flow ratio (QFR) is a novel, noninvasive, vasodilator-free method used to assess the hemodynamic significance of coronary stenoses. We aimed to investigate the incremental value of QFR over angiography in nonculprit lesions in patients with ST-segment-elevation myocardial infarction undergoing angiography-guided complete revascularization. Methods and Results This was a retrospective post hoc QFR analysis of untreated nontarget vessels (any degree of diameter stenosis [DS]) from the randomized multicenter COMFORTABLE AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction) trial by assessors blinded for clinical outcomes. The primary end point was cardiac death, spontaneous nontarget vessel myocardial infarction, and clinically indicated nontarget vessel revascularization (ie, ≥70% DS by 2-dimensional quantitative coronary angiography or ≥50% DS and ischemia) at 5 years. Of 1161 patients with ST-segment-elevation myocardial infarction, 946 vessels in 617 patients were analyzable by QFR. At 5 years, the rate of the primary end point was significantly higher in patients with QFR ≤0.80 (n=35 patients, n=36 vessels) versus QFR >0.80 (n=582 patients, n=910 vessels) (62.9% versus 12.5%, respectively; hazard ratio [HR], 7.33 [95% CI, 4.54-11.83], P<0.001), driven by higher rates of nontarget vessel myocardial infarction (12.8% versus 3.1%, respectively; HR, 4.38 [95% CI, 1.47-13.02], P=0.008) and nontarget vessel revascularization (58.6% versus 7.7%, respectively; HR, 10.99 [95% CI, 6.39-18.91], P<0.001) with no significant differences for cardiac death. Multivariable analysis identified QFR ≤0.80 but not ≥50% DS by 3-dimensional quantitative coronary angiography as an independent predictor of the primary end point. Results were consistent, including only >30% DS by 3-dimensional quantitative coronary angiography. Conclusions Our study suggests incremental value of QFR over angiography-guided percutaneous coronary intervention for nonculprit lesions among patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention.
More Related Videos
05:07Author Spotlight: Improved Localization and Monitoring of Coronary Flow Reserve Using Modified PLAX View in Mice
Published on: August 25, 2023
12:00Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014