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Quantitative flow ratio-based revascularization on clinical outcomes in multivessel disease STEMI patients with
Huimin Xian1, Yanzong Liu2, Yongpeng Zou1
1Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.
Insights
Patients with multivessel disease and ST-elevation myocardial infarction (MVD-STEMI) benefit from quantitative flow ratio (QFR)-based revascularization. Chronic kidney disease (CKD) patients showed greater risk reduction with QFR, indicating its enhanced prognostic capability in this population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Nephrology
Background:
- Multivessel disease and ST-elevation myocardial infarction (MVD-STEMI) carry a poor prognosis.
- Quantitative flow ratio (QFR)-based revascularization improves outcomes in MVD-STEMI patients.
- The impact of chronic kidney disease (CKD) on QFR benefits is not well understood.
Purpose of the Study:
- To compare clinical outcomes of QFR-based revascularization in MVD-STEMI patients with and without CKD.
- To assess the influence of CKD on the efficacy of QFR-guided treatment strategies.
- To evaluate the prognostic value of QFR-derived scores in CKD patients.
Main Methods:
- 495 MVD-STEMI patients undergoing primary percutaneous coronary intervention (PCI) were analyzed.
- Patients were categorized into non-CKD and CKD cohorts.
- Functional complete revascularization (FCR) versus functional incomplete revascularization (FIR) was determined by QFR, with 3-year major adverse cardiovascular events (MACEs) as the primary outcome.
Main Results:
- FCR was associated with lower MACE incidence than FIR in both non-CKD and CKD groups (p=0.014, p=0.008).
- CKD patients experienced a greater percentage decrease in MACEs from FIR to FCR (53.1%) compared to non-CKD patients (49.7%).
- The residual SYNTAX score derived from QFR (RSSQFR) strongly predicted MACEs and improved prediction models, particularly in the CKD cohort.
Conclusions:
- CKD patients with MVD-STEMI demonstrated a greater absolute risk reduction with QFR-based revascularization.
- This enhanced benefit in CKD may stem from higher baseline risk or improved QFR efficacy.
- QFR-based scoring systems possess stronger prognostic predictive ability in the CKD population.
Background:
Patients with multivessel disease and ST-elevation myocardial infarction (MVD-STEMI) have a poor prognosis but benefit from quantitative flow ratio (QFR)-based revascularization. The influence of chronic kidney disease (CKD) on this benefit is unclear. This study aimed to evaluate differences in clinical outcomes of QFR-based revascularization in MVD-STEMI patients with or without CKD.
Methods:
A total of 495 patients with MVD-STEMI who underwent primary percutaneous coronary intervention (PCI) were included in the study. Patients were divided into nonCKD and CKD cohort, and were further stratified into functional complete revascularization (FCR) and functional incomplete revascularization (FIR) layer based on QFR assessments. The primary outcomes were 3-year major adverse cardiovascular events (MACEs).
Results:
The incidence of MACEs was lower in FCR than FIR layers in both nonCKD and CKD cohorts (p = 0.014, p = 0.008), but the percentage decrease in MACEs from FIR to FCR in CKD was greater than that in nonCKD cohort (53.1 % vs 49.7 %). The baseline QFR measurements were significantly lower in FIR patients with CKD than with nonCKD (p < 0.001). The residual SYNTAX score derived from QFR (RSSQFR) was significantly associated with the increased risk of MACEs in both cohorts (p < 0.001). Incorporating RSSQFR into prognostic models improved MACE prediction, especially in CKD cohort than in nonCKD cohort (difference in area under the curve = -0.143 vs difference in area under the curve = -0.133).
Conclusions:
In MVD-STEMI patients, the CKD population showed greater absolute risk reduction, which could be attributed to either their higher baseline risk or possible enhanced QFR efficacy. The ability of the QFR-based scoring system to predict prognosis was stronger in the CKD population than in the nonCKD population.
