Prognostic impact of quantitative flow ratio (QFR)-consistent complete revascularization in patients with myocardial infarction and multivessel coronary artery disease

IF 3.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American heart journal Pub Date : 2024-07-20 DOI:10.1016/j.ahj.2024.07.011

Aslihan Erbay MD , Lisa Penzel MD , Youssef S. Abdelwahed MD , Andrea Heuberger MD , Anne-Sophie Schatz MD , Claudio Seppelt MD , Lara S. Schlender MD , Julia Steiner MD , Arash Haghikia MD , Sebastian Steven MD , Ulf Landmesser MD , Barbara E. Stähli MD , David M. Leistner MD

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Abstract

Background

Complete revascularization is associated with improved outcomes in patients with myocardial infarction and multivessel coronary artery disease. Quantitative flow ratio (QFR) represents an emerging angiography-based tool for functional lesion assessment. The present study investigated the prognostic impact of QFR-consistent complete revascularization in patients with myocardial infarction and multivessel disease.

Methods

A total of 792 patients with myocardial infarction and multivessel disease were enrolled in the analysis. Post-hoc QFR analyses of 1,320 nonculprit vessels were performed by investigators blinded to clinical outcomes. The primary endpoint was a composite of all-cause death, nonculprit vessel related nonfatal myocardial infarction, and ischemia-driven revascularization at 2 years after index myocardial infarction. Patients were stratified into a QFR-consistent PCI group (n = 646) and a QFR-inconsistent PCI group (n = 146), based on whether the intervention was congruent with the QFR-determined functional significance of the nonculprit lesions.

Results

The primary endpoint occurred in a total of 22 patients (3.4%) in the QFR-consistent PCI group and in 27 patients (18.5%) in the QFR-inconsistent group (HR 0.17, 95% CI 0.10-0.30, P < .001).The difference in the primary endpoint was driven by reduced rates of nonfatal myocardial infarction (2.0% vs. 15.1%; HR 0.13, 95% CI 0.06-0.25; P < .001) and ischemia-driven revascularization (1.2% vs. 5.5%; HR 0.21, 95% CI 0.08-0.57; P = .001) in the QFR-consistent PCI group.

Conclusions

Among patients with myocardial infarction and multivessel disease, a QFR-consistent complete revascularization was associated with a reduced risk of all-cause mortality, nonfatal myocardial infarction, and ischemia-driven revascularization. These findings underline the value of angiography-based functional lesion assessment for personalized revascularization strategies.

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心肌梗死和多支血管冠状动脉疾病患者定量血流比（QFR）一致性完全血管再通的预后影响。

背景：完全血管再通与改善心肌梗死和多支冠状动脉疾病患者的预后有关。定量血流比（QFR）是一种新兴的基于血管造影的功能性病变评估工具。本研究调查了心肌梗死和多支血管疾病患者中QFR一致的完全血管再通对预后的影响：方法：共有 792 名心肌梗死和多支血管疾病患者参与分析。对临床结果保密的研究人员对 1320 条非梗死血管进行了事后 QFR 分析。主要终点是指数性心肌梗死发生两年后的全因死亡、与非梗死血管相关的非致死性心肌梗死和缺血驱动的血管再通的复合终点。根据干预是否符合QFR确定的非病灶功能意义，将患者分为符合QFR的PCI组（646人）和不符合QFR的PCI组（146人）：符合QFR的PCI组共有22名患者（3.4%）出现主要终点，不符合QFR的PCI组共有27名患者（18.5%）出现主要终点（HR 0.17，95%CI 0.10-0.30，p结论：在心肌梗死和多支血管疾病患者中，QFR一致的完全血管再通与全因死亡率、非致死性心肌梗死和缺血驱动的血管再通风险降低相关。这些发现强调了基于血管造影的功能性病变评估对个性化血管再通策略的价值。

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来源期刊

American heart journal 医学-心血管系统

CiteScore

8.20

自引率

2.10%

发文量

214

审稿时长

38 days

期刊介绍： The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.