Prognostic role of discordance between quantitative flow ratio and visual estimation in revascularization guidance.

European heart journal open Pub Date : 2023-12-26 eCollection Date: 2024-01-01 DOI:10.1093/ehjopen/oead125
Dimitrios Terentes-Printzios, Dimitrios Oikonomou, Konstantia-Paraskevi Gkini, Vasiliki Gardikioti, Konstantinos Aznaouridis, Ioanna Dima, Konstantinos Tsioufis, Charalambos Vlachopoulos
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Abstract

Aims: Revascularization guided by functional severity has presented improved outcomes compared with visual angiographic guidance. Quantitative flow ratio (QFR) is a reliable angiography-based method for functional assessment. We sought to investigate the prognostic value of discordance between QFR and visual estimation in coronary revascularization guidance.

Methods and results: We performed offline QFR analysis on all-comers undergoing coronary angiography. Vessels with calculated QFR were divided into four groups based on the decision to perform or defer percutaneous coronary intervention (PCI) and on the QFR result, i.e.: Group A (PCI-, QFR > 0.8); Group B (PCI+, QFR ≤ 0.8); Group C (PCI+, QFR > 0.8); Group D (PCI-, QFR ≤ 0.8). Patients with at least one vessel falling within the disagreement groups formed the discordance group, whereas the remaining patients formed the concordance group. The primary endpoint was the composite endpoint of cardiovascular death, myocardial infarction, and ischaemia-driven revascularization. Overall, 546 patients were included in the study. Discordance between QFR and visual estimation was found in 26.2% of patients. After a median follow-up period of 2.5 years, the discordance group had a significantly higher rate of the composite outcome (hazard ratio: 3.34, 95% confidence interval 1.99-5.60, P < 0.001). Both disagreement vessel Groups C and D were associated with increased cardiovascular risk compared with agreement Groups A and B.

Conclusion: Discordance between QFR and visual estimation in revascularization guidance was associated with a worse long-term prognosis. Our results highlight the importance of proper patient selection for intervention and the need to avoid improper stent implantations when not dictated by a comprehensive functional assessment.

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定量血流比值与目测血流比值不一致在血管重建指导中的预后作用。
目的:与可视血管造影指导相比,以功能严重程度为指导的血管再通治疗效果更好。定量血流比(QFR)是一种可靠的基于血管造影的功能评估方法。我们试图研究在冠状动脉血运重建指导中,QFR 和视觉估计值不一致的预后价值:我们对所有接受冠状动脉造影术的患者进行了离线 QFR 分析。根据是否实施或推迟经皮冠状动脉介入治疗(PCI)的决定和 QFR 结果,将计算出 QFR 的血管分为四组,即:A 组(PCI-,QFR > 0.8);B 组(PCI+,QFR ≤ 0.8);C 组(PCI+,QFR > 0.8);D 组(PCI-,QFR ≤ 0.8)。至少有一根血管属于分歧组的患者组成分歧组,其余患者组成一致组。主要终点是心血管死亡、心肌梗死和缺血导致的血管再通的复合终点。研究共纳入了 546 名患者。26.2%的患者的QFR与目测结果不一致。中位随访 2.5 年后,不一致组的综合结果发生率明显更高(危险比:3.34,95% 置信区间 1.99-5.60,P <0.001)。与A组和B组相比,C组和D组血管不一致与心血管风险增加有关:结论:在血管重建指导中,QFR 和目测之间的不一致与较差的长期预后有关。我们的研究结果凸显了正确选择患者进行介入治疗的重要性,以及避免在未进行全面功能评估的情况下不当植入支架的必要性。
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