Taku Asano1, Yuki Katagiri2, Chun Chin Chang3, Norihiro Kogame2, Ply Chichareon2, Kuniaki Takahashi2, Rodrigo Modolo2, Erhan Tenekecioglu3, Carlos Collet4, Hans Jonker5, Clare Appleby6, Azfar Zaman7, Nicolas van Mieghem3, Neal Uren8, Javier Zueco9, Jan J Piek2, Johan H C Reiber10, Vasim Farooq11, Javier Escaned12, Adrian P Banning13, Patrick W Serruys14, Yoshinobu Onuma15. 1. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan. 2. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 3. ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands. 4. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Universitair Ziekenhuis Brussels, Brussels, Belgium. 5. Cardialysis, Rotterdam, the Netherlands. 6. Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom. 7. Department of Cardiology, Freeman Hospital Newcastle, Newcastle upon Tyne, United Kingdom. 8. Department of Cardiology, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. 9. Department of Cardiology, Hospital Universitario Valdecilla, Cantabria, Spain. 10. Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. 11. Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, United Kingdom. 12. Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain. 13. Department of Cardiology, John Radcliffe Hospital, Cardiology, Oxford, United Kingdom. 14. ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: patrick.w.j.c.serruys@gmail.com. 15. ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
Abstract
OBJECTIVES: The aims of the present study were to investigate the applicability of quantitative flow ratio (QFR) in patients with 3-vessel disease and to demonstrate the impact of functional SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score derived from QFR (fSSQFR) on clinical outcomes. BACKGROUND: The applicability of QFR in patients with 3-vessel disease and the feasibility of fSSQFR have not yet been investigated. METHODS: All lesions interrogated using instantaneous wave-free ratio and/or fractional flow reserve in the SYNTAX II trial were retrospectively screened and analyzed for QFR. The diagnostic performance of QFR was investigated using hybrid wire-derived pressure assessment (instantaneous wave-free ratio and fractional flow reserve), used in the trial as a reference. Patients with analyzable QFR in 3 vessels were stratified according to fSSQFR to evaluate its clinical prognostic value on the basis of 2-year patient-oriented composite endpoint. RESULTS: QFRs were analyzable in 71.0% of lesions (836 lesions). The diagnostic performance of QFR to predict binary wire-based ischemia was substantial (area under the curve 0.81, accuracy 73.8%), with a positive predictive value of 85.9%. Independent predictors of diagnostic discordance were lesions in side branches, involvement of bifurcation or trifurcation, and small vessel. According to the 2-year patient-oriented composite endpoint, fSSQFR reclassified 26.1% of the patients (36 of 138) in the high- to intermediate-risk group into the low-risk group appropriately (net reclassification improvement 0.32; p < 0.001). The area under the curve for fSSQFR to predict the 2-year patient-oriented composite endpoint was higher than that of the classic anatomic SYNTAX score (0.68 vs. 0.56; p = 0.002). CONCLUSIONS: QFR demonstrated substantial applicability in patients with 3-vessel disease. The fSSQFR has the potential to further refine prognostic risk estimation compared with the classic anatomic SYNTAX score.
OBJECTIVES: The aims of the present study were to investigate the applicability of quantitative flow ratio (QFR) in patients with 3-vessel disease and to demonstrate the impact of functional SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score derived from QFR (fSSQFR) on clinical outcomes. BACKGROUND: The applicability of QFR in patients with 3-vessel disease and the feasibility of fSSQFR have not yet been investigated. METHODS: All lesions interrogated using instantaneous wave-free ratio and/or fractional flow reserve in the SYNTAX II trial were retrospectively screened and analyzed for QFR. The diagnostic performance of QFR was investigated using hybrid wire-derived pressure assessment (instantaneous wave-free ratio and fractional flow reserve), used in the trial as a reference. Patients with analyzable QFR in 3 vessels were stratified according to fSSQFR to evaluate its clinical prognostic value on the basis of 2-year patient-oriented composite endpoint. RESULTS: QFRs were analyzable in 71.0% of lesions (836 lesions). The diagnostic performance of QFR to predict binary wire-based ischemia was substantial (area under the curve 0.81, accuracy 73.8%), with a positive predictive value of 85.9%. Independent predictors of diagnostic discordance were lesions in side branches, involvement of bifurcation or trifurcation, and small vessel. According to the 2-year patient-oriented composite endpoint, fSSQFR reclassified 26.1% of the patients (36 of 138) in the high- to intermediate-risk group into the low-risk group appropriately (net reclassification improvement 0.32; p < 0.001). The area under the curve for fSSQFR to predict the 2-year patient-oriented composite endpoint was higher than that of the classic anatomic SYNTAX score (0.68 vs. 0.56; p = 0.002). CONCLUSIONS: QFR demonstrated substantial applicability in patients with 3-vessel disease. The fSSQFR has the potential to further refine prognostic risk estimation compared with the classic anatomic SYNTAX score.
Authors: Mina Ghobrial; Hazel Arfah Haley; Rebecca Gosling; Vignesh Rammohan; Patricia V Lawford; D Rod Hose; Julian P Gunn; Paul D Morris Journal: Heart Date: 2021-01-08 Impact factor: 5.994