Future culprit detection based on angiography-derived FFR.

Area of Science:

• Cardiology
• Medical Imaging
• Vascular Biology

Background:

• The diagnostic accuracy of fractional flow reserve (FFR) in identifying significant coronary artery disease (CAD) in mild cases can be limited.
• Quantitative flow ratio (QFR) offers an alternative, angiography-derived method to assess hemodynamic significance.

Purpose of the Study:

• To investigate the hemodynamic characteristics of mild coronary stenoses that subsequently lead to myocardial infarction (MI).
• To evaluate the utility of quantitative flow ratio (QFR) in predicting future adverse events in patients with non-significant CAD at baseline.

Main Methods:

• Retrospective analysis of patients who experienced MI and had prior coronary angiography within 5 years.
• Quantitative coronary angiography, QFR, and lesion length analysis were performed on both future culprit lesions (FCL) and non-culprit lesions (NCL).

Main Results:

• Future culprit lesions (FCL) demonstrated greater diameter stenosis (%DS) and lower QFR compared to non-culprit lesions (NCL).
• The difference in QFR between FCL and NCL was more pronounced when the interval between angiograms was less than 2 years.
• Lesions with lower baseline QFR were associated with an earlier occurrence of MI.

Conclusions:

• Mild coronary stenoses that eventually cause MI exhibit distinct hemodynamic profiles (lower QFR, higher %DS) years prior to the event.
• Baseline QFR may serve as a predictor for the timing of MI in patients with mild CAD.