The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Angiography-derived functional assessment of non-culprit coronary stenoses during primary percutaneous coronary intervention for ST-elevation myocardial infarction.

DOI: 10.4244/EIJ-D-18-01165

1. Hospital Clinico Universitario San Carlos, Interventional Cardiology Unit, Madrid, Madrid, Spain
2. Hospital Clínico San Carlos, Madrid (Spain)
3. Hospital Clínico San Carlos, Madrid (Spain)
4. Hospital Clínico San Carlos, Madrid (Spain)
5. King’s College Hospital, London (United Kingdom)
6. Toda Chuo General Hospital (Japan)
7. Department of Mathematics, Universidad de León (Spain)
8. Hospital Clínico San Carlos, Madrid (Spain)
9. King’s College Hospital, London (United Kingdom)
10. Hospital Clínico San Carlos, Madrid (Spain)
11. Hospital Clínico San Carlos, Madrid (Spain)
12. King’s College Hospital, London (United Kingdom)
13. Hospital Clinic San Carlos, Madrid (Spain), Spain

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Aims: Functional assessment of non-culprit lesions (NCL) in patients presenting with ST-elevation myocardial infarction (STEMI) and multivessel disease constitutes an unmet need. This study aims to evaluate the diagnostic accuracy of Quantitative Flow Ratio (QFR) in functional assessment of NCL during acute phase of STEMI. 

Methods and results: Retrospective, observational, multicenter study including patients with STEMI and staged Fractional Flow Reserve (FFR) assessment of NCL. QFR in NCL was calculated from the coronary angiogram acquired during primary PCI in a blinded fashion with respect to FFR. The diagnostic value of QFR in the STEMI population was compared with a propensity-score-matched population of stable angina patients. 82 patients (91 NCL) were included. Target lesions were of both angiographic and functional (mean FFR 0.82 ± 0.09) intermediate severity. Diagnostic performance of QFR was high (AUC 0.91 [95% CI, 0.85-0.97]) and similar to that observed in the matched control population (AUC 0.91 vs. 0.94, p=0.5). The diagnostic accuracy of QFR was very high (>95%) in those vessels (61.5%) with QFR values out of a ROC-defined “grey zone” (0.75-0.85). A hybrid FFR/QFR approach (FFR only when QFR in grey zone) would adequately classify 96.7% NCL, avoiding 58.5% of repeat diagnostic procedures. 

Conclusions: QFR has a good diagnostic accuracy in assessing functional relevance of NCL during primary PCI, similar to the accuracy observed in stable patients.

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