Clinical Value of Single-Projection Angiography–Derived FFR in Noninfarct-Related Artery-Reference-Cited by-同舟云学术

Clinical Value of Single-Projection Angiography–Derived FFR in Noninfarct-Related Artery

Published:2024-05 Issue:5 Volume:17 Page:
ISSN:1941-7640
Container-title:Circulation: Cardiovascular Interventions
language:en
Short-container-title:Circ: Cardiovascular Interventions

Author:

Kwon Woochan¹^ORCID,Choi Ki Hong¹^ORCID,Lee Seung Hun²^ORCID,Hong David¹^ORCID,Shin Doosup³^ORCID,Kim Hyun Kuk⁴^ORCID,Park Keun Ho⁴^ORCID,Choo Eun Ho⁵^ORCID,Kim Chan Joon⁶,Kim Min Chul²^ORCID,Hong Young Joon²^ORCID,Ahn Sung Gyun⁷^ORCID,Doh Joon-Hyung⁸^ORCID,Lee Sang Yeub⁹^ORCID,Park Sang Don¹⁰^ORCID,Lee Hyun-Jong¹¹^ORCID,Kang Min Gyu¹²^ORCID,Koh Jin-Sin¹²^ORCID,Cho Yun-Kyeong¹³^ORCID,Nam Chang-Wook¹³^ORCID,Joh Hyun Sung¹⁴^ORCID,Kyu Park Taek¹^ORCID,Yang Jeong Hoon¹^ORCID,Song Young Bin¹^ORCID,Choi Seung-Hyuk¹^ORCID,Jeong Myung Ho²,Gwon Hyeon-Cheol¹^ORCID,Hahn Joo-Yong¹^ORCID,Lee Joo Myung¹^ORCID,

Affiliation:

1. Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.).

2. Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea (S.H.L., M.C.K., Y.J.H., M.H.J.).

3. Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC (D.S.).

4. Chosun University Hospital, University of Chosun College of Medicine, Gwangju, South Korea (H.K.K., K.H.P.).

5. Seoul St. Mary’s Hospital, The Catholic University of Korea, South Korea (E.H.C.).

6. The Catholic University of Korea, Uijeongbu St. Mary’s Hospital, Seoul, South Korea (C.J.K.).

7. Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, South Korea (S.G.A.).

8. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.).

9. Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, South Korea (S.Y.L.).

10. Inha University Hospital, Incheon, South Korea (S.D.P.).

11. Sejong General Hospital, Bucheon, South Korea (H.-J.L.).

12. Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, South Korea (M.G.K., J.-S.K.).

13. Keimyung University Dongsan Medical Center, Daegu, South Korea (Y.-K.C., C.-W.N.).

14. Seoul National University Boramae Medical Center, Seoul National University College of Medicine, South Korea (H.S.J.).

Abstract

BACKGROUND: The Murray law–based quantitative flow ratio (μFR) is an emerging technique that requires only 1 projection of coronary angiography with similar accuracy to quantitative flow ratio (QFR). However, it has not been validated for the evaluation of noninfarct-related artery (non-IRA) in acute myocardial infarction (AMI) settings. Therefore, our study aimed to evaluate the diagnostic accuracy of μFR and the safety of deferring non-IRA lesions with μFR >0.80 in the setting of AMI. METHODS: μFR and QFR were analyzed for non-IRA lesions of patients with AMI enrolled in the FRAME-AMI trial (Fractional Flow Reserve Versus Angiography-Guided Strategy for Management of Non-Infarction Related Artery Stenosis in Patients With Acute Myocardial Infarction), consisting of fractional flow reserve (FFR)–guided percutaneous coronary intervention and angiography-guided percutaneous coronary intervention groups. The diagnostic accuracy of μFR was compared with QFR and FFR. Patients were classified by the non-IRA μFR value of 0.80 as a cutoff value. The primary outcome was a vessel-oriented composite outcome, a composite of cardiac death, non-IRA–related myocardial infarction, and non-IRA–related repeat revascularization. RESULTS: μFR and QFR analyses were feasible in 443 patients (552 lesions). μFR showed acceptable correlation with FFR (R=0.777; P <0.001), comparable C-index with QFR to predict FFR ≤0.80 (μFR versus QFR: 0.926 versus 0.961, P =0.070), and shorter total analysis time (mean, 32.7 versus 186.9 s; P <0.001). Non-IRA with μFR >0.80 and deferred percutaneous coronary intervention had a significantly lower risk of vessel-oriented composite outcome than non-IRA with performed percutaneous coronary intervention (3.4% versus 10.5%; hazard ratio, 0.37 [95% CI, 0.14–0.99]; P =0.048). CONCLUSIONS: In patients with multivessel AMI, μFR of non-IRA showed acceptable diagnostic accuracy comparable to that of QFR to predict FFR ≤0.80. Deferred non-IRA with μFR >0.80 showed a lower risk of vessel-oriented composite outcome than revascularized non-IRA. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02715518.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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