Quantitative Flow Ratio Identifies Nonculprit Coronary Lesions Requiring Revascularization in Patients with ST-Segment-Elevation Myocardial Infarction and Multivessel Disease

Carlo Trani, Mario Sabatelli, Gaetano Spitaleri, Antonio Maria Leone, Rosandra Ferrario, Gabriella Campoli, Giosafat Spitaleri, Matteo Tebaldi, Simone Biscaglia, Jelmer Westra, Salvatore Brugaletta, Andrea Erriquez, Giulia Passarini, Alessandro Brieda, Andrea Picchi, Alfonso Ielasi, Domenico Di Girolamo, Roberto Ferrari, Johan H.C. Reiber, Marco ValgimigliManel Sabatè, Gianluca Campo

Risultato della ricerca: Contributo in rivistaArticolo in rivista

34 Citazioni (Scopus)

Abstract

Background - The nonculprit lesion (NCL) management in ST-segment-elevation myocardial infarction patients with multivessel disease is debated. We sought to assess whether quantitative flow ratio (QFR), a noninvasive tool to identify potentially flow-limiting lesions, may be reliable in this scenario. Methods and Results - The present proof-of-concept study is based on a 3-step process: (1) identification of the QFR reproducibility in NCLs assessment (cohort A, n=31); (2) prospective validation of QFR diagnostic accuracy in respect to fractional flow reserve (cohort B, n=45); and (3) investigation of long-term clinical outcomes of NCLs stratified according to QFR (cohort C, n=110). A blinded core laboratory computed QFR values for all NCLs. Cohort A showed a good correlation and agreement between QFR values at index (acute) and at staged (subacute, 3-4 days later) procedures (r=0.98; 95% confidence interval, 0.96-0.99; mean difference, 0.004 [-0.027 to 0.34]). The inter-rater agreement was κ=0.9. In cohort B, fractional flow reserve and QFR identified 16 (33%) and 17 (35%) NCLs potentially flow limiting. Sensitivity, specificity, negative, and positive predictive values were 88%, 97%, 94%, and 94%. The area under the receiver operating characteristics curve was 0.96 (95% confidence interval, 0.89-0.99). Finally, in cohort C, we identified 110 ST-segment-elevation myocardial infarction patients where at least 1 NCL was left untreated. Patients with NCLs showing a QFR value ≤0.80 were at higher risk of adverse events (hazard ratio, 2.3; 95% confidence interval, 1.2-4.5; P=0.01). Conclusions - In a limited and selected study population, our study showed that QFR computation may be a safe and reliable tool to guide coronary revascularization of NCLs in ST-segment-elevation myocardial infarction patients.
Lingua originaleEnglish
pagine (da-a)e006023-N/A
RivistaCIRCULATION. CARDIOVASCULAR INTERVENTIONS.
Volume11
DOI
Stato di pubblicazionePubblicato - 2018

Keywords

  • Aged
  • Blood Flow Velocity
  • Clinical Decision-Making
  • Coronary Angiography
  • Coronary Artery Disease
  • Coronary Circulation
  • Coronary Stenosis
  • Coronary Vessels
  • Female
  • Fractional Flow Reserve, Myocardial
  • Humans
  • Imaging, Three-Dimensional
  • Male
  • Middle Aged
  • Myocardial Revascularization
  • Predictive Value of Tests
  • Proof of Concept Study
  • Prospective Studies
  • Radiographic Image Interpretation, Computer-Assisted
  • Reproducibility of Results
  • Retrospective Studies
  • ST Elevation Myocardial Infarction
  • Severity of Illness Index
  • adenosine
  • coronary artery disease
  • coronary stenosis
  • informed consent
  • sensitivity and specificity

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