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Murray law-based quantitative flow ratio for assessment of nonculprit lesions in patients with ST-segment elevation
Xinjian Li1,2,3,4, Lin Mi1,2,3,4, Juntao Duan1,2,3,4
1Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China.
Insights
Quantitative Flow Ratio (μQFR) can assess nonculprit arteries in ST-Segment Myocardial Infarction (STEMI) patients. Acute μQFR measurements correlate well with staged assessments, proving its feasibility and value.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Revascularization of nonculprit arteries is recommended for ST-Segment Elevation Myocardial Infarction (STEMI) patients.
- Optimal therapeutic strategies for nonculprit lesions in STEMI remain unclear.
- Quantitative Flow Ratio (μQFR) offers a novel, non-invasive method for assessing coronary artery stenosis severity.
Purpose of the Study:
- To evaluate the feasibility and correlation of μQFR in assessing nonculprit arteries during the acute phase of STEMI.
- To compare acute μQFR measurements with staged evaluations in STEMI patients.
Main Methods:
- Retrospective analysis of STEMI patients who underwent staged percutaneous coronary intervention (PCI).
- μQFR analysis of nonculprit vessels using both acute and staged coronary angiography.
- Correlation and agreement assessment between acute and staged μQFR values.
Main Results:
- 110 nonculprit arteries from 84 STEMI patients were analyzed.
- A strong correlation (r=0.719) was observed between acute and staged μQFR.
- High classification agreement (89.09%) and a significant area under the ROC curve (0.931) for detecting functionally significant lesions.
Conclusions:
- Calculating μQFR during the acute phase of STEMI is feasible.
- Acute and staged μQFR measurements demonstrate good correlation and agreement.
- μQFR is a potentially valuable tool for assessing the functional significance of nonculprit arteries in STEMI patients.
Introduction:
Revascularization of nonculprit arteries in patients with ST-Segment Elevation Myocardial Infarction (STEMI) is now recommended based on several trials. However, the optimal therapeutic strategy of nonculprit lesions remains unknown. Murray law-based Quantitative Flow Ratio (μQFR) is a novel, non-invasive, vasodilator-free method for evaluating the functional severity of coronary artery stenosis, which has potential applications for nonculprit lesion assessment in STEMI patients.
Material And Methods:
Patients with STEMI who received staged PCI before hospital discharge were enrolled retrospectively. μQFR analyses of nonculprit vessels were performed based on both acute and staged angiography.
Results:
Eighty-four patients with 110 nonculprit arteries were included. The mean acute μQFR was 0.76 ± 0.18, and the mean staged μQFR was 0.75 ± 0.19. The average period between acute and staged evaluation was 8 days. There was a good correlation (r = 0.719, P < 0.001) between acute μQFR and staged μQFR. The classification agreement was 89.09%. The area under the receiver operator characteristic (ROC) curve for detecting staged μQFR ≤ 0.80 was 0.931.
Conclusions:
It is feasible to calculate the μQFR during the acute phase of STEMI patients. Acute μQFR and staged μQFR have a good correlation and agreement. The μQFR could be a valuable method for assessing functional significance of nonculprit arteries in STEMI patients.
