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The efficacy and safety of quantitative flow ratio-guided complete revascularization in patients with ST-segment
Jing Zhang1,2, Mingyan Yao3, Xinwei Jia4
1Department of Cardiology, Thoracic Clinical College, Tianjin Medical University, Tianjin, China.
Insights
Quantitative flow ratio-guided complete revascularization (QFR-G-CR) in ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) patients significantly reduces major adverse cardiovascular events. This strategy offers a benefit over treating only the infarct-related artery (IRA) in the acute phase.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Treatment strategy for non-infarct-related arteries (non-IRA) in ST-segment elevation myocardial infarction (STEMI) with multivessel disease (MVD) is debated.
- Quantitative flow ratio (QFR) is an emerging angiography-based physiological index with limited clinical application data.
Purpose of the Study:
- To evaluate the clinical efficacy and safety of QFR-guided complete revascularization (QFR-G-CR) for non-IRA lesions in STEMI patients with MVD.
- To compare QFR-G-CR with infarct-related artery (IRA)-only percutaneous coronary intervention (PCI).
Main Methods:
- A randomized controlled trial involving 229 patients with STEMI and MVD.
- Patients were assigned to either QFR-G-CR of non-IRA or IRA-only PCI.
- Primary endpoint: composite of all-cause death, non-fatal myocardial infarction (MI), and ischemia-driven revascularization at 12 months.
Main Results:
- QFR-G-CR group showed a significantly lower rate of the primary endpoint (9.6% vs. 20.1%; HR: 0.45; p=0.025).
- Incidence of unstable angina was also reduced in the QFR-G-CR group (5.2% vs. 14.0%; HR: 0.36; p=0.026).
- No significant differences in massive bleeding or contrast-associated acute kidney injury (CAKI) between groups.
Conclusions:
- QFR-G-CR of non-IRA lesions is beneficial for STEMI and MVD patients during the acute phase.
- This approach reduces major adverse cardiovascular events and unstable angina compared to IRA-only treatment.
- QFR guidance offers a promising strategy for complete revascularization in STEMI with MVD.
Background:
In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), the treatment strategy for non-infarct-related artery (non-IRA) remains controversial. Quantitative flow ratio (QFR) is a new angiography-based physiological assessment index. However, there is little evidence on the practical clinical application of QFR.
Methods:
Two hundred and twenty-nine patients with STEMI and MVD were recruited for this study. Patients were randomly assigned to either receive QFR-guided complete revascularization (QFR-G-CR) of non-IRA or receive no further invasive treatment. The primary (1°) endpoint analyzed included death due to all causes, non-fatal myocardial infarction (MI), and ischemia-induced revascularization at 12 months post-surgery. Secondary (2°) endpoints included cardiovascular death, unstable angina, stent thrombosis, New York Heart Association (NYHA) class IV heart failure, and stroke at 1 year post surgery. Massive bleeding and contrast-associated acute kidney injury (CAKI) were used as safety endpoints.
Results:
Around the 12 month follow up, the 1o outcome was recorded in 11/115 patients (9.6%) in the QFR-G-CR population, relative to 23/114 patients (20.1%) in the IRA-only PCI population (hazard ratio [HR]: 0.45; 95% confidence interval [CI]: 0.22-0.92; p = 0.025). Unstable angina in 6 (5.2%) and 16 (14.0%) patients (HR: 0.36; 95% CI: 0.14-0.92; p = 0.026), respectively. No marked alterations were found in the massive bleeding and CAKI categories.
Conclusions:
In conclusion, STEMI and MVD patients can benefit from QFR-G-CR of non-IRA lesions in the initial stages of acute MI. This can help reduce incidences of major adverse cardiovascular events and unstable angina, relative to IRA treatment only. Chinese Clinical Trial Registration number: ChiCTR2100044120.
