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Quantitative flow ratio for immediate assessment of nonculprit lesions in patients with ST-segment elevation myocardial infarction—An iSTEMI substudy

Sejr-Hansen, Martin ; Westra, Jelmer ; Thim, Troels ; Christiansen, Evald Høj ; Eftekhari, Ashkan ; Kristensen, Steen Dalby ; Jakobsen, Lars ; Götberg, Matthias LU ; Frøbert, Ole and van der Hoeven, Nina W. , et al. (2019) In Catheterization and Cardiovascular Interventions 94(5). p.686-692
Abstract

Objectives: We evaluated the diagnostic performance of quantitative flow ratio (QFR) assessment of nonculprit lesions (NCLs) based on acute setting angiograms obtained in patients with ST-segment elevation myocardial infarction (STEMI) with QFR, fractional flow reserve (FFR), and instantaneous wave-free ratio (iFR) in the staged setting as reference. Background: QFR is an angiography-based approach for the functional evaluation of coronary artery lesions. Methods: This was a post-hoc analysis of the iSTEMI study. NCLs were assessed with iFR in the acute setting and with iFR and FFR at staged (median 13 days) follow-up. Acute and staged QFR values were computed in a core laboratory based on the coronary angiography recordings. Diagnostic... (More)

Objectives: We evaluated the diagnostic performance of quantitative flow ratio (QFR) assessment of nonculprit lesions (NCLs) based on acute setting angiograms obtained in patients with ST-segment elevation myocardial infarction (STEMI) with QFR, fractional flow reserve (FFR), and instantaneous wave-free ratio (iFR) in the staged setting as reference. Background: QFR is an angiography-based approach for the functional evaluation of coronary artery lesions. Methods: This was a post-hoc analysis of the iSTEMI study. NCLs were assessed with iFR in the acute setting and with iFR and FFR at staged (median 13 days) follow-up. Acute and staged QFR values were computed in a core laboratory based on the coronary angiography recordings. Diagnostic cut-off values were ≤0.80 for QFR and FFR, and ≤0.89 for iFR. Results: Staged iFR and FFR data were available for 146 NCLs in 112 patients in the iSTEMI study. Among these, QFR analysis was feasible in 103 (71%) lesions assessed in the acute setting with a mean QFR value of 0.82 (IQR: 0.73–0.91). Staged QFR, FFR, and iFR were 0.80 (IQR: 0.70–0.90), 0.81 (IQR: 0.71–0.88), and 0.91 (IQR: 0.87–0.96), respectively. Classification agreement of acute and staged QFR was 93% (95%Cl: 87–99). The classification agreement of acute QFR was 84% (95%CI: 76–90) using staged FFR as reference and 74% (95%CI: 65–83) using staged iFR as reference. Conclusions: Acute QFR showed a very good diagnostic performance with staged QFR as reference, a good diagnostic performance with staged FFR as reference, and a moderate diagnostic performance with staged iFR as reference.

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publication status
published
subject
keywords
FFR, fractional flow reserve, iFR, instantaneous wave-free ratio, QFR, STEMI
in
Catheterization and Cardiovascular Interventions
volume
94
issue
5
pages
686 - 692
publisher
Wiley-Blackwell
external identifiers
  • pmid:30912257
  • scopus:85063402034
ISSN
1522-1946
DOI
10.1002/ccd.28208
language
English
LU publication?
yes
id
a772ac95-209a-4d65-bae5-4c3b0d92fbfd
date added to LUP
2019-04-10 14:02:24
date last changed
2020-07-09 03:00:19
@article{a772ac95-209a-4d65-bae5-4c3b0d92fbfd,
  abstract     = {<p>Objectives: We evaluated the diagnostic performance of quantitative flow ratio (QFR) assessment of nonculprit lesions (NCLs) based on acute setting angiograms obtained in patients with ST-segment elevation myocardial infarction (STEMI) with QFR, fractional flow reserve (FFR), and instantaneous wave-free ratio (iFR) in the staged setting as reference. Background: QFR is an angiography-based approach for the functional evaluation of coronary artery lesions. Methods: This was a post-hoc analysis of the iSTEMI study. NCLs were assessed with iFR in the acute setting and with iFR and FFR at staged (median 13 days) follow-up. Acute and staged QFR values were computed in a core laboratory based on the coronary angiography recordings. Diagnostic cut-off values were ≤0.80 for QFR and FFR, and ≤0.89 for iFR. Results: Staged iFR and FFR data were available for 146 NCLs in 112 patients in the iSTEMI study. Among these, QFR analysis was feasible in 103 (71%) lesions assessed in the acute setting with a mean QFR value of 0.82 (IQR: 0.73–0.91). Staged QFR, FFR, and iFR were 0.80 (IQR: 0.70–0.90), 0.81 (IQR: 0.71–0.88), and 0.91 (IQR: 0.87–0.96), respectively. Classification agreement of acute and staged QFR was 93% (95%Cl: 87–99). The classification agreement of acute QFR was 84% (95%CI: 76–90) using staged FFR as reference and 74% (95%CI: 65–83) using staged iFR as reference. Conclusions: Acute QFR showed a very good diagnostic performance with staged QFR as reference, a good diagnostic performance with staged FFR as reference, and a moderate diagnostic performance with staged iFR as reference.</p>},
  author       = {Sejr-Hansen, Martin and Westra, Jelmer and Thim, Troels and Christiansen, Evald Høj and Eftekhari, Ashkan and Kristensen, Steen Dalby and Jakobsen, Lars and Götberg, Matthias and Frøbert, Ole and van der Hoeven, Nina W. and Holm, Niels Ramsing and Maeng, Michael},
  issn         = {1522-1946},
  language     = {eng},
  number       = {5},
  pages        = {686--692},
  publisher    = {Wiley-Blackwell},
  series       = {Catheterization and Cardiovascular Interventions},
  title        = {Quantitative flow ratio for immediate assessment of nonculprit lesions in patients with ST-segment elevation myocardial infarction—An iSTEMI substudy},
  url          = {http://dx.doi.org/10.1002/ccd.28208},
  doi          = {10.1002/ccd.28208},
  volume       = {94},
  year         = {2019},
}