Concordance between vessel-specific and vascular territory coronary functional assessment: A comparison of...

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Accuracy

Background:

• Coronary artery disease (CAD) assessment relies on Quantitative flow ratio (QFR) and myocardial perfusion scintigraphy (MPS).
• Understanding the concordance and prognostic value of these methods is crucial for clinical decision-making.

Purpose of the Study:

• To analyze the concordance between QFR and MPS in evaluating CAD significance.
• To compare the prognostic impact of QFR and MPS on major adverse cardiovascular events.

Main Methods:

• Patients with invasive coronary angiography, QFR, and MPS were categorized based on concordance criteria.
• Concordance was assessed by coronary territory involvement.
• Leaman score was used to evaluate coronary atherosclerotic burden.

Main Results:

• A total of 2010 coronary territories from 670 patients were analyzed.
• Concordance rates included total (52.5%), partial (29.1%), poor (15.8%), and total discordance (2.6%).
• Higher atherosclerotic burden (Leaman score) and MPS perfusion defects were independent predictors of discordance.
• Leaman score, functional Leaman score, and average QFR better stratified risk for death/myocardial infarction than MPS after 1400 days.

Conclusions:

• While MPS shows overall accuracy, substantial discordance with QFR exists in CAD assessment.
• Predictors for discordance include atherosclerotic burden and perfusion defects.
• QFR-derived metrics provide superior risk stratification for adverse cardiovascular outcomes compared to MPS.