TY - JOUR
T1 - Quantitative flow ratio to predict nontarget vessel– related events at 5 years in patients with st-segment– elevation myocardial infarction undergoing angiography-guided revascularization
AU - Bär, Sarah
AU - Kavaliauskaite, Raminta
AU - Ueki, Yasushi
AU - Otsuka, Tatsuhiko
AU - Kelbæk, Henning
AU - Engstrøm, Thomas
AU - Baumbach, Andreas
AU - Roffi, Marco
AU - von Birgelen, Clemens
AU - Ostojic, Miodrag
AU - Pedrazzini, Giovanni
AU - Kornowski, Ran
AU - Tüller, David
AU - Vukcevic, Vladan
AU - Magro, Michael
AU - Losdat, Sylvain
AU - Windecker, Stephan
AU - Räber, Lorenz
N1 - Funding Information:
Dr Bär reports grants to the institution from Medis Medical Imaging Systems, outside the submitted work. Dr Ueki reports personal fees from Infraredex, outside the submitted work. Professor Engstrøm reports personal fees from Abbott, AstraZeneca, Bayer, Boston Scientific, and Novo Nordisk, outside of the submitted work. Professor Baumbach reports institutional research support from Abbott Vascular and speaker or consultation fees from Astra Zeneca, Sinomed, Microport, Abbott Vascular, Cardinal Health, and KSH, outside the submitted work. Professor von Birgelen reports institutional research grants from Abbott Vascular, Biotronik, Boston Scientific, and Medtronic, outside the submitted work. Professor Kornowski is the cofounder and a minor shareholder on CathWorks, unrelated to the submitted work. Professor Windecker reports research and educational grants from Abbott, Amgen, Boston Scientific, Biotronik, BMS, Bayer, CLS Behring, Edwards Lifesciences, Medtronic, Polares, and Sinomed, outside the submitted work. Professor Räber reports research grants to the institution from Abbott Vascular, Biotronik, Boston Scientific, Heartflow, Sanofi, and Regeneron Medis Medical Imaging Systems, and speaker or consultation fees by Abbott Vascular, Amgen, AstraZeneca, CSL Behring, Occlutech, Sanofi, and Vifor, outside the submitted work. The remaining authors have no disclosures to report.
Publisher Copyright:
© 2021 The Authors.
PY - 2021/5/4
Y1 - 2021/5/4
N2 - BACKGROUND: In ST-segment– elevation myocardial infarction, angiography-based complete revascularization is superior to culprit-lesion-only percutaneous coronary intervention. Quantitative flow ratio (QFR) is a novel, noninvasive, vasodilator-free method used to assess the hemodynamic significance of coronary stenoses. We aimed to investigate the incremental value of QFR over angiography in nonculprit lesions in patients with ST-segment– elevation myocardial infarction undergoing angiography-guided complete revascularization. METHODS AND RESULTS: This was a retrospective post hoc QFR analysis of untreated nontarget vessels (any degree of diam-eter stenosis [DS]) from the randomized multicenter COMFORTABLE AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction) trial by assessors blinded for clinical outcomes. The primary end point was cardiac death, spontaneous nontarget vessel myocardial infarction, and clinically indicated nontarget vessel revascularization (ie, ≥70% DS by 2-dimensional quantitative coronary angiography or ≥50% DS and ischemia) at 5 years. Of 1161 patients with ST-segment– elevation myocardial infarction, 946 vessels in 617 patients were analyzable by QFR. At 5 years, the rate of the primary end point was significantly higher in patients with QFR ≤0.80 (n=35 patients, n=36 vessels) versus QFR >0.80 (n=582 patients, n=910 vessels) (62.9% versus 12.5%, respectively; hazard ratio [HR], 7.33 [95% CI, 4.54–11.83], P<0.001), driven by higher rates of nontarget vessel myocardial infarction (12.8% versus 3.1%, respectively; HR, 4.38 [95% CI, 1.47–13.02], P=0.008) and nontarget vessel revascularization (58.6% versus 7.7%, respectively; HR, 10.99 [95% CI, 6.39–18.91], P<0.001) with no significant differences for cardiac death. Multivariable analysis identified QFR ≤0.80 but not ≥50% DS by 3-dimensional quantitative coronary angiography as an independent predictor of the primary end point. Results were consistent, including only >30% DS by 3-dimensional quantitative coronary angiography. CONCLUSIONS: Our study suggests incremental value of QFR over angiography-guided percutaneous coronary intervention for nonculprit lesions among patients with ST-segment– elevation myocardial infarction undergoing primary percutaneous coronary intervention.
AB - BACKGROUND: In ST-segment– elevation myocardial infarction, angiography-based complete revascularization is superior to culprit-lesion-only percutaneous coronary intervention. Quantitative flow ratio (QFR) is a novel, noninvasive, vasodilator-free method used to assess the hemodynamic significance of coronary stenoses. We aimed to investigate the incremental value of QFR over angiography in nonculprit lesions in patients with ST-segment– elevation myocardial infarction undergoing angiography-guided complete revascularization. METHODS AND RESULTS: This was a retrospective post hoc QFR analysis of untreated nontarget vessels (any degree of diam-eter stenosis [DS]) from the randomized multicenter COMFORTABLE AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction) trial by assessors blinded for clinical outcomes. The primary end point was cardiac death, spontaneous nontarget vessel myocardial infarction, and clinically indicated nontarget vessel revascularization (ie, ≥70% DS by 2-dimensional quantitative coronary angiography or ≥50% DS and ischemia) at 5 years. Of 1161 patients with ST-segment– elevation myocardial infarction, 946 vessels in 617 patients were analyzable by QFR. At 5 years, the rate of the primary end point was significantly higher in patients with QFR ≤0.80 (n=35 patients, n=36 vessels) versus QFR >0.80 (n=582 patients, n=910 vessels) (62.9% versus 12.5%, respectively; hazard ratio [HR], 7.33 [95% CI, 4.54–11.83], P<0.001), driven by higher rates of nontarget vessel myocardial infarction (12.8% versus 3.1%, respectively; HR, 4.38 [95% CI, 1.47–13.02], P=0.008) and nontarget vessel revascularization (58.6% versus 7.7%, respectively; HR, 10.99 [95% CI, 6.39–18.91], P<0.001) with no significant differences for cardiac death. Multivariable analysis identified QFR ≤0.80 but not ≥50% DS by 3-dimensional quantitative coronary angiography as an independent predictor of the primary end point. Results were consistent, including only >30% DS by 3-dimensional quantitative coronary angiography. CONCLUSIONS: Our study suggests incremental value of QFR over angiography-guided percutaneous coronary intervention for nonculprit lesions among patients with ST-segment– elevation myocardial infarction undergoing primary percutaneous coronary intervention.
KW - Angiography
KW - Coronary flow
KW - Elevation myocardial infarction
KW - Fractional flow reserve
KW - ST-segment
UR - http://www.scopus.com/inward/record.url?scp=85105906499&partnerID=8YFLogxK
U2 - 10.1161/JAHA.120.019052
DO - 10.1161/JAHA.120.019052
M3 - Article
C2 - 33899509
AN - SCOPUS:85105906499
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 9
M1 - e019052
ER -
