Clinical Value of Single-Projection Angiography-Derived FFR in Noninfarct-Related Artery.

IF 6.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation: Cardiovascular Interventions Pub Date : 2024-05-01 Epub Date: 2024-05-21 DOI:10.1161/CIRCINTERVENTIONS.123.013844

Woochan Kwon, Ki Hong Choi, Seung Hun Lee, David Hong, Doosup Shin, Hyun Kuk Kim, Keun Ho Park, Eun Ho Choo, Chan Joon Kim, Min Chul Kim, Young Joon Hong, Sung Gyun Ahn, Joon-Hyung Doh, Sang Yeub Lee, Sang Don Park, Hyun-Jong Lee, Min Gyu Kang, Jin-Sin Koh, Yun-Kyeong Cho, Chang-Wook Nam, Hyun Sung Joh, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Seung-Hyuk Choi, Myung Ho Jeong, Hyeon-Cheol Gwon, Joo-Yong Hahn, Joo Myung Lee

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Abstract

Background: The Murray law-based quantitative flow ratio (μFR) is an emerging technique that requires only 1 projection of coronary angiography with similar accuracy to quantitative flow ratio (QFR). However, it has not been validated for the evaluation of noninfarct-related artery (non-IRA) in acute myocardial infarction (AMI) settings. Therefore, our study aimed to evaluate the diagnostic accuracy of μFR and the safety of deferring non-IRA lesions with μFR >0.80 in the setting of AMI.

Methods: μFR and QFR were analyzed for non-IRA lesions of patients with AMI enrolled in the FRAME-AMI trial (Fractional Flow Reserve Versus Angiography-Guided Strategy for Management of Non-Infarction Related Artery Stenosis in Patients With Acute Myocardial Infarction), consisting of fractional flow reserve (FFR)-guided percutaneous coronary intervention and angiography-guided percutaneous coronary intervention groups. The diagnostic accuracy of μFR was compared with QFR and FFR. Patients were classified by the non-IRA μFR value of 0.80 as a cutoff value. The primary outcome was a vessel-oriented composite outcome, a composite of cardiac death, non-IRA-related myocardial infarction, and non-IRA-related repeat revascularization.

Results: μFR and QFR analyses were feasible in 443 patients (552 lesions). μFR showed acceptable correlation with FFR (R=0.777; P<0.001), comparable C-index with QFR to predict FFR ≤0.80 (μFR versus QFR: 0.926 versus 0.961, P=0.070), and shorter total analysis time (mean, 32.7 versus 186.9 s; P<0.001). Non-IRA with μFR >0.80 and deferred percutaneous coronary intervention had a significantly lower risk of vessel-oriented composite outcome than non-IRA with performed percutaneous coronary intervention (3.4% versus 10.5%; hazard ratio, 0.37 [95% CI, 0.14-0.99]; P=0.048).

Conclusions: In patients with multivessel AMI, μFR of non-IRA showed acceptable diagnostic accuracy comparable to that of QFR to predict FFR ≤0.80. Deferred non-IRA with μFR >0.80 showed a lower risk of vessel-oriented composite outcome than revascularized non-IRA.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02715518.

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非梗死相关动脉单次投影血管造影得出的 FFR 临床价值

背景：基于默里定律的定量血流比（μFR）是一种新兴技术，只需冠状动脉造影的一次投影，准确性与定量血流比（QFR）相似。然而，在评估急性心肌梗死（AMI）中的非梗死相关动脉（non-IRA）时，该技术尚未得到验证。因此，我们的研究旨在评估μFR的诊断准确性，以及在AMI情况下推迟μFR>0.80的非IRA病变的安全性。方法：对参加 FRAME-AMI 试验（急性心肌梗死患者非梗死相关动脉狭窄管理的分数血流储备与血管造影引导策略）的 AMI 患者的非 IRA 病变的 μFR 和 QFR 进行分析，该试验包括分数血流储备（FFR）引导的经皮冠状动脉介入治疗组和血管造影引导的经皮冠状动脉介入治疗组。μFR的诊断准确性与QFR和FFR进行了比较。以非 IRA μFR 值 0.80 为临界值对患者进行分类。主要结果是以血管为导向的综合结果，即心源性死亡、非 IRA 相关心肌梗死和非 IRA 相关重复血管再通的综合结果。结果：μFR 和 QFR 分析适用于 443 例患者（552 个病变）。070），总分析时间更短（平均为 32.7 秒对 186.9 秒；P0.80），与进行经皮冠状动脉介入治疗的非 IRA 相比，延迟经皮冠状动脉介入治疗的血管导向复合结局风险显著更低（3.4% 对 10.5%；危险比为 0.37 [95% CI, 0.14-0.99]; P=0.048）：在多血管急性心肌梗死患者中，非IRA的μFR在预测FFR≤0.80方面显示出与QFR相当的可接受的诊断准确性。与血管再通的非IRA相比，μFR>0.80的延迟非IRA显示出较低的血管导向复合结局风险：URL：https://www.clinicaltrials.gov；唯一标识符：NCT02715518。

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来源期刊

Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

1.80%

发文量

221

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.