Prediction of functional results of percutaneous coronary interventions with virtual stenting and quantitative flow ratio
- Authors
- Lee, Hyun-Jong; Mejia-Renteria, Hernan; Escaned, Javier; Doh, Joon-Hyung; Lee, Joo Myung; Hwang, Doyeon; Yuasa, Sonoka; Choi, Ki Hong; Jang, Ho-Jun; Jeon, Ki-Hyun; Lee, Juneyoung; Nam, Chang-Wook; Shin, Eun-Seok; Koo, Bon-Kwon
- Issue Date
- Nov-2022
- Publisher
- John Wiley & Sons Inc.
- Keywords
- coronary angiography; coronary physiology; coronary stents; fractional flow reserve; PCI optimization; PCI outcomes; percutaneous coronary intervention; quantitative flow ratio
- Citation
- Catheterization and Cardiovascular Interventions, v.100, no.7, pp 1208 - 1217
- Pages
- 10
- Indexed
- SCIE
SCOPUS
- Journal Title
- Catheterization and Cardiovascular Interventions
- Volume
- 100
- Number
- 7
- Start Page
- 1208
- End Page
- 1217
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/61816
- DOI
- 10.1002/ccd.30451
- ISSN
- 1522-1946
1522-726X
- Abstract
- Background
The clinical value of residual quantitative flow ratio (rQFR), a novel function of QFR technique, is unknown.
Aim
We investigated the clinical value of rQFR, aimed to predict residual ischemia after virtual percutaneous coronary intervention (vPCI).
Methods
This is a substudy of the COE-PERSPECTIVE registry, which investigated the prognostic value of post-PCI fractional flow reserve (FFR). From pre-PCI angiograms, QFR and rQFR were analyzed and their diagnostic performance was assessed at blinded fashion using pre-PCI FFR and post-PCI FFR as reference, respectively. The prognostic value of rQFR after vPCI was assessed according to vessel-oriented composite outcome (VOCO) at 2 years.
Results
We analyzed 274 patients (274 vessels) with FFR-based ischemic causing lesions (49%) from 555 screened patients. Pre-PCI QFR and FFR were 0.63 ± 0.10 and 0.66 ± 0.11 (R = 0.756, p < 0.001). rQFR after vPCI and FFR after real PCI were 0.93 ± 0.06 and 0.86 ± 0.07 (R = 0.528, p < 0.001). The mean difference between rQFR and post-PCI FFR was 0.068 (95% limit of agreement: −0.05 to 0.19). Diagnostic performance of rQFR to predict residual ischemia after PCI was good (area under the curve [AUC]: 0.856 [0.804−0.909], p < 0.001). rQFR predicted well the incidence of 2-year VOCO after index PCI (AUC: 0.712 [0.555−0.869], p = 0.041), being similar to that of actual post-PCI FFR (AUC: 0.691 [0.512−0.870], p = 0.061). rQFR ≤0.89 was associated with increased risk of 2-year VOCO (hazard ratio [HR]: 12.9 [2.32−71.3], p = 0.0035). This difference was mainly driven by a higher rate of target vessel revascularization (HR: 16.98 [2.33−123.29], p = 0.0051).
Conclusions
rQFR estimated from pre-PCI angiography and virtual coronary stenting mildly overestimated functional benefit of PCI. However, it well predicted suboptimal functional result and long-term vessel-related clinical events.
Clinical Trial Registration
Influence of fractional flow reserve on the Clinical OutcomEs of PERcutaneouS Coronary Intervention (COE-PESPECTIVE) Registry, NCT01873560
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- Appears in
Collections - 1. Basic Science > Department of Biostatistics > 1. Journal Articles
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