Norihiro Kogame1, Kuniaki Takahashi2, Mariusz Tomaniak3, Ply Chichareon2, Rodrigo Modolo2, Chun Chin Chang4, Hidenori Komiyama2, Yuki Katagiri2, Taku Asano2, Rod Stables5, Farzin Fath-Ordoubadi6, Simon Walsh7, Manel Sabaté8, Justin E Davies9, Jan J Piek2, Robert-Jan van Geuns10, Johan H C Reiber11, Adrian P Banning12, Javier Escaned13, Vasim Farooq14, Patrick W Serruys15, Yoshinobu Onuma4. 1. Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Toho University medical center Ohashi hospital, Tokyo, Japan. Electronic address: https://twitter.com/KogameNorihiro. 2. Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands. 3. Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. 4. Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. 5. Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom. 6. Manchester Heart Centre, Manchester Royal Infirmary, Manchester University Foundation Trusts, Manchester, United Kingdom. 7. Department of Cardiology, Royal Victoria Hospital, Belfast, Northern Ireland. 8. Interventional Cardiology Department, Cardiovascular Institute, University Clinic Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain. 9. Royal Brompton Hospital, Imperial College London, London, United Kingdom. 10. Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; Cardiology Department, Radboud UMC, Nijmegen, the Netherlands. 11. Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. 12. Department of Cardiology, John Radcliffe Hospital, Cardiology, Oxford, United Kingdom. 13. Department of Cardiology, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos and Universidad Complutense de Madrid, Madrid, Spain. 14. Department of Cardiology, University Hospital Wales, Cardiff, United Kingdom. 15. International Centre for Circulatory Health, Imperial College London, London, United Kingdom. Electronic address: patrick.w.j.c.serruys@gmail.com.
Abstract
OBJECTIVES: The aim of this study was to investigate the impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) on clinical outcomes in patients with de novo 3-vessel disease (3VD) treated with contemporary PCI. BACKGROUND: The clinical impact of post-PCI QFR in patients treated with state-of-the-art PCI for de novo 3VD is undetermined. METHODS: All vessels treated in the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) II trial were retrospectively screened and analyzed for post-PCI QFR. The primary endpoint of this substudy was vessel-oriented composite endpoint (VOCE) at 2 years, defined as the composite of vessel-related cardiac death, vessel-related myocardial infarction, and target vessel revascularization. The receiver-operating characteristic curve was used to calculate the optimal cutoff value of post-PCI QFR for predicting 2-year VOCE. All the analyzable vessels were stratified on the basis of the optimal cutoff value. RESULTS: A total of 968 vessels treated with PCI were screened. Post-PCI QFR was analyzable in 771 (79.6%) vessels. A total of 52 (6.7%) VOCEs occurred at 2 years. The mean value of post-PCI QFR was 0.91 ± 0.07. The diagnostic performance of post-PCI QFR to predict 2-year VOCE was moderate (area under the curve: 0.702; 95% confidence interval: 0.633 to 0.772), with the optimal cutoff value of post-PCI QFR for predicting 2-year VOCE 0.91 (sensitivity 0.652, specificity 0.635). The incidence of 2-year VOCE in the vessels with post-PCI QFR <0.91 (n = 284) was significantly higher compared with vessels with post-PCI QFR ≥0.91 (n = 487) (12.0% vs. 3.7%; hazard ratio: 3.37; 95% confidence interval: 1.91 to 5.97; p < 0.001). CONCLUSIONS: A higher post-PCI QFR value is associated with improved vessel-related clinical outcomes in state-of-the art PCI practice for de novo 3VD. Achieving a post-PCI QFR value ≥0.91 in all treated vessels should be a target when treating de novo 3VD. These findings require confirmation in future prospective trials.
OBJECTIVES: The aim of this study was to investigate the impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) on clinical outcomes in patients with de novo 3-vessel disease (3VD) treated with contemporary PCI. BACKGROUND: The clinical impact of post-PCI QFR in patients treated with state-of-the-art PCI for de novo 3VD is undetermined. METHODS: All vessels treated in the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) II trial were retrospectively screened and analyzed for post-PCI QFR. The primary endpoint of this substudy was vessel-oriented composite endpoint (VOCE) at 2 years, defined as the composite of vessel-related cardiac death, vessel-related myocardial infarction, and target vessel revascularization. The receiver-operating characteristic curve was used to calculate the optimal cutoff value of post-PCI QFR for predicting 2-year VOCE. All the analyzable vessels were stratified on the basis of the optimal cutoff value. RESULTS: A total of 968 vessels treated with PCI were screened. Post-PCI QFR was analyzable in 771 (79.6%) vessels. A total of 52 (6.7%) VOCEs occurred at 2 years. The mean value of post-PCI QFR was 0.91 ± 0.07. The diagnostic performance of post-PCI QFR to predict 2-year VOCE was moderate (area under the curve: 0.702; 95% confidence interval: 0.633 to 0.772), with the optimal cutoff value of post-PCI QFR for predicting 2-year VOCE 0.91 (sensitivity 0.652, specificity 0.635). The incidence of 2-year VOCE in the vessels with post-PCI QFR <0.91 (n = 284) was significantly higher compared with vessels with post-PCI QFR ≥0.91 (n = 487) (12.0% vs. 3.7%; hazard ratio: 3.37; 95% confidence interval: 1.91 to 5.97; p < 0.001). CONCLUSIONS: A higher post-PCI QFR value is associated with improved vessel-related clinical outcomes in state-of-the art PCI practice for de novo 3VD. Achieving a post-PCI QFR value ≥0.91 in all treated vessels should be a target when treating de novo 3VD. These findings require confirmation in future prospective trials.
Authors: Zuoyi Zhou; Baozhen Zhu; Fangfang Fan; Fan Yang; Shu Fang; Zhi Wang; Lin Qiu; Yanjun Gong; Yong Huo Journal: Front Cardiovasc Med Date: 2022-03-21