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Quantitative flow ratio for immediate assessment of nonculprit lesions in patients with ST‐segment elevation myocardial infarction—An iSTEMI substudy
Author(s) -
SejrHansen Martin,
Westra Jelmer,
Thim Troels,
Christiansen Evald Høj,
Eftekhari Ashkan,
Kristensen Steen Dalby,
Jakobsen Lars,
Götberg Matthias,
Frøbert Ole,
Hoeven Nina W.,
Holm Niels Ramsing,
Maeng Michael
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28208
Subject(s) - medicine , fractional flow reserve , cardiology , myocardial infarction , coronary angiography , diagnostic accuracy
Abstract Objectives We evaluated the diagnostic performance of quantitative flow ratio (QFR) assessment of nonculprit lesions (NCLs) based on acute setting angiograms obtained in patients with ST‐segment elevation myocardial infarction (STEMI) with QFR, fractional flow reserve (FFR), and instantaneous wave‐free ratio (iFR) in the staged setting as reference. Background QFR is an angiography‐based approach for the functional evaluation of coronary artery lesions. Methods This was a post‐hoc analysis of the iSTEMI study. NCLs were assessed with iFR in the acute setting and with iFR and FFR at staged (median 13 days) follow‐up. Acute and staged QFR values were computed in a core laboratory based on the coronary angiography recordings. Diagnostic cut‐off values were ≤0.80 for QFR and FFR, and ≤0.89 for iFR. Results Staged iFR and FFR data were available for 146 NCLs in 112 patients in the iSTEMI study. Among these, QFR analysis was feasible in 103 (71%) lesions assessed in the acute setting with a mean QFR value of 0.82 (IQR: 0.73–0.91). Staged QFR, FFR, and iFR were 0.80 (IQR: 0.70–0.90), 0.81 (IQR: 0.71–0.88), and 0.91 (IQR: 0.87–0.96), respectively. Classification agreement of acute and staged QFR was 93% (95%Cl: 87–99). The classification agreement of acute QFR was 84% (95%CI: 76–90) using staged FFR as reference and 74% (95%CI: 65–83) using staged iFR as reference. Conclusions Acute QFR showed a very good diagnostic performance with staged QFR as reference, a good diagnostic performance with staged FFR as reference, and a moderate diagnostic performance with staged iFR as reference.