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

Quantitative Flow Ratio guided Residual Functional SYNTAX Score for Risk Assessment in Patients with ST-Segment Elevation Myocardial Infarction undergoing Percutaneous Coronary Intervention

DOI: 10.4244/EIJ-D-19-00369

1. Tongji Hospital, Tongji University, Department of Cardiology, Shanghai, China, China
2. Department of Cardiology, Tongji Hospital, Tongji University, Shanghai, China
3. Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
4. Department of Cardiology, Tongji Hospital, Tongji University, Shanghai, China
5. Department of Cardiology, Tongji Hospital, Tongji University, Shanghai, China
6. Department of Cardiology, Tongji Hospital, Tongji University, Shanghai, China
7. Department of Cardiology, Tongji Hospital, Tongji University, Shanghai, China
8. Department of Cardiology, Tongji Hospital, Tongji University, Shanghai, China
9. Department of Cardiology, Tongji Hospital, Tongji University, Shanghai, China
10. Department of Cardiology, Tongji Hospital, Tongji University, Shanghai, China
11. Department of Cardiac Surgery, Zhongshan hospital, Fudan University, Shanghai, China
12. Department of Cardiology, Tongji Hospital, Tongji University, Shanghai, China, Department of Cardiology, Shanghai, CHINA
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Aims: This study was aimed at investigating the prognostic ability of quantitative flow ratio (QFR) guided residual functional SYNTAX score (Q-rFSS) and functional incomplete revascularization (IR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). 

Methods and results: A total of consecutive 354 STEMI patients was included. Q-rFSS was defined as residual SYNTAX score (rSS) measured in vessels with QFR ≤0.8. At 2-year follow-up, functional IR (Q-rFSS≥1) showed significantly higher risk for major adverse cardiac events (MACE) than functional complete revascularization (CR) (Q-rFSS=0) (functional IR vs. CR, 22.0% vs. 7.4%; hazard ratio: 3.21; 95% confidence interval (Cl): 1.74 to 5.91; p<0.001). The area under curve (AUC) of Q-rFSS (0.738, 95% CI: 0.659 to 0.817) was significantly greater than that of rSS (0.648, 95% CI: 0.547 to 0.749). C-statistic for MACE increased from 0.656 (0.582 to 0.729) to 0.767 (0.705 to 0.829) after the addition of Q-rFSS to the clinical risk factors. Q-rFSS significantly improved risk classification compared with rSS (net reclassification improvement 0.439, 95% CI: 0.201 to 0.548; p<0.001). 

Conclusions: Functional IR is associated with higher risk of MACE during long-term follow-up in STEMI patients undergoing PCI. Q-rFSS has a better prognostic ability for the risk of MACE.

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