OBJECTIVES: The aim of this study was to examine the level of agreement between acute instantaneous wave-free ratio (iFR) measured across nonculprit stenoses in patients with ST-segment elevation myocardial infarction (STEMI) and iFR measured at a staged follow-up procedure. BACKGROUND: Acute full revascularization of nonculprit stenoses in STEMI is debated and currently guided by angiography. Acute functional assessment of nonculprit stenoses may be considered. METHODS: Immediately after successful primary culprit intervention for STEMI, nonculprit coronary stenoses were evaluated with iFR and left untreated. Follow-up evaluation with iFR was performed at a later stage. iFR <0.90 was considered hemodynamically significant. RESULTS: One hundred twenty patients with 157 nonculprit lesions were included. Median acute iFR was 0.89 (interquartile range [IQR]: 0.82 to 0.94; n = 156), and median follow-up iFR was 0.91 (interquartile range: 0.86 to 0.96; n = 147). Classification agreement was 78% between acute and follow-up iFR. The negative predictive value of acute iFR was 89%. Median time from acute to follow-up evaluation was 16 days (IQR: 5 to 32 days). With follow-up within 5 days after STEMI, no difference was observed between acute and follow-up iFR, and classification agreement was 89%. With follow-up ≥16 days after STEMI, acute iFR was lower than follow-up iFR, and classification agreement was 70%. CONCLUSIONS: Acute iFR evaluation appeared valid for ruling out significant nonculprit stenoses in patients with STEMI undergoing primary percutaneous coronary intervention. The time interval from acute to follow-up iFR influenced classification agreement, suggesting that inherent physiological disarrangements during STEMI may contribute to classification disagreement.
OBJECTIVES: The aim of this study was to examine the level of agreement between acute instantaneous wave-free ratio (iFR) measured across nonculprit stenoses in patients with ST-segment elevation myocardial infarction (STEMI) and iFR measured at a staged follow-up procedure. BACKGROUND: Acute full revascularization of nonculprit stenoses in STEMI is debated and currently guided by angiography. Acute functional assessment of nonculprit stenoses may be considered. METHODS: Immediately after successful primary culprit intervention for STEMI, nonculprit coronary stenoses were evaluated with iFR and left untreated. Follow-up evaluation with iFR was performed at a later stage. iFR <0.90 was considered hemodynamically significant. RESULTS: One hundred twenty patients with 157 nonculprit lesions were included. Median acute iFR was 0.89 (interquartile range [IQR]: 0.82 to 0.94; n = 156), and median follow-up iFR was 0.91 (interquartile range: 0.86 to 0.96; n = 147). Classification agreement was 78% between acute and follow-up iFR. The negative predictive value of acute iFR was 89%. Median time from acute to follow-up evaluation was 16 days (IQR: 5 to 32 days). With follow-up within 5 days after STEMI, no difference was observed between acute and follow-up iFR, and classification agreement was 89%. With follow-up ≥16 days after STEMI, acute iFR was lower than follow-up iFR, and classification agreement was 70%. CONCLUSIONS: Acute iFR evaluation appeared valid for ruling out significant nonculprit stenoses in patients with STEMI undergoing primary percutaneous coronary intervention. The time interval from acute to follow-up iFR influenced classification agreement, suggesting that inherent physiological disarrangements during STEMI may contribute to classification disagreement.
Authors: Tim P van de Hoef; Joo Myung Lee; Mauro Echavarria-Pinto; Bon-Kwon Koo; Hitoshi Matsuo; Manesh R Patel; Justin E Davies; Javier Escaned; Jan J Piek Journal: Nat Rev Cardiol Date: 2020-05-14 Impact factor: 32.419
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Authors: Hernán Mejía-Rentería; Joo Myung Lee; Nina W van der Hoeven; Nieves Gonzalo; Pilar Jiménez-Quevedo; Luis Nombela-Franco; Iván J Núñez-Gil; Pablo Salinas; María Del Trigo; Enrico Cerrato; Niels van Royen; Paul Knaapen; Bon-Kwon Koo; Carlos Macaya; Antonio Fernández-Ortiz; Javier Escaned Journal: J Am Heart Assoc Date: 2019-05-07 Impact factor: 5.501
Authors: Casper W H Beijnink; Troels Thim; Dirk Jan van der Heijden; Igor Klem; Rasha Al-Lamee; Jacqueline L Vos; Yvonne Koop; Marcel G W Dijkgraaf; Marcel A M Beijk; Raymond J Kim; Justin Davies; Luis Raposo; Sérgio B Baptista; Javier Escaned; Jan J Piek; Michael Maeng; Niels van Royen; Robin Nijveldt Journal: BMJ Open Date: 2021-01-15 Impact factor: 2.692
Authors: Troels Thim; Matthias Götberg; Ole Fröbert; Robin Nijveldt; Niels van Royen; Sergio Bravo Baptista; Sasha Koul; Thomas Kellerth; Hans Erik Bøtker; Christian Juhl Terkelsen; Evald Høj Christiansen; Lars Jakobsen; Steen Dalby Kristensen; Michael Maeng Journal: BMC Res Notes Date: 2020-09-01
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