Agreement between nonculprit stenosis follow-up iFR and FFR after STEMI (iSTEMI substudy)

Thim, Troels; Götberg, Matthias; Fröbert, Ole; Nijveldt, Robin; Royen, Niels van; Baptista, Sérgio Bravo; Koul, Sasha; Kellerth, Thomas; Bøtker, Hans Erik; Terkelsen, Christian Juhl; Christiansen, Evald Høj; Jakobsen, Lars; Kristensen, Steen Dalby; Mæng, Michael

doi:10.1186/s13104-020-05252-6

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…In another iSTEMI substudy, the same authors concluded that the time interval between STEMI and the physiologic interrogation impact the agreement between FFR and iFR: the longer delay, the better the agreement. 32 A recent review concluded that transient changes in physiology immediately after STEMI may result in iFR overestimating and FFR underestimating nIRA lesion significance. 33 On the other hand, in a porcine model of microvascular injury, FFR was shown to be unchanged in remote (“nonculprit”) vessels 34 ; of note, 97% of the nIRA with discrepant FFR and Pd/Pa were remote from the IRA in our study.…”

Section: Discussionmentioning

confidence: 99%

Correlation and Relative Prognostic Value of Fractional Flow Reserve and Pd/Pa of Nonculprit Lesions in ST-Segment–Elevation Myocardial Infarction

Piróth

Fülöp

Klerk

et al. 2022

Circ: Cardiovascular Interventions

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Background: The applicability of resting indices to guide noninfarct-related artery revascularization in ST-elevation myocardial infarction is unknown. Methods: We analyzed the correlation and prognostic value of fractional flow reserve (FFR) and resting distal coronary to aortic pressure ratio (Pd/Pa) in all patients of the Compare-Acute trial in whom, after successful primary percutaneous coronary intervention, the noninfarct-related artery was interrogated by both and treated medically. The treating cardiologist was blinded to these values. The primary end point was the composite of target vessel (interrogated noninfarct-related artery) related nonfatal target vessel myocardial infarction and target vessel repeat revascularization at 36 months. Results: Five hundred seventeen patients (665 vessels) were included. On receiver-operating characteristic analysis, the optimal Pd/Pa cut off for FFR≤0.80 was 0.905 ( C statistic: 0.894). The diagnostic accuracy of Pd/Pa was 80.15% (95% CI, 76.91%–83.12%) with respect to FFR. During the 36-month follow-up, 130 target vessel revascularization and 14 target vessel myocardial infarction occurred. FFR and Pd/Pa had a diagnostic accuracy to predict these events of 62.86% (95% CI, 59.06%–66.54%) and 56.84% (95% CI, 52.98%–60.64%), respectively ( P =0.20). When they were discrepant, FFR was significantly better than Pd/Pa in identifying which vessels could be safely deferred ( P =0.048). Conclusions: Immediately after successful primary percutaneous coronary intervention, resting Pd/Pa has a diagnostic accuracy of 80% with respect to FFR measured in the noninfarct-related artery. FFR is not significantly superior in predicting target vessel myocardial infarction and target vessel revascularization during 36 months of follow-up but, in case FFR and Pd/Pa are discrepant, FFR is superior in identifying which nonculprit vessels can be safely deferred. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01399736.

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Section: Discussionmentioning

confidence: 99%

Correlation and Relative Prognostic Value of Fractional Flow Reserve and Pd/Pa of Nonculprit Lesions in ST-Segment–Elevation Myocardial Infarction

Piróth

Fülöp

Klerk

et al. 2022

Circ: Cardiovascular Interventions

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“… 41 , 74 Currently, it is unknown how long these effects remain present after myocardial infarction. 75 …”

Section: Practical Aspects and Patient Selectionmentioning

confidence: 99%

Fractional Flow Reserve: Patient Selection and Perspectives

Peper

Becker

Kuijk

et al. 2021

VHRM

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“…The physiological changes during STEMI may impact the classi cation disagreement in the more extended follow-up period [21]. It was noted that iFR could overdiagnose the severity of stenoses, and FFR can undervalue in the acute and subacute phases in STEMI patients [22]. Theoretically, the iFR could be used in ACS patients [23], but it still prolongs procedure time, requires pressure wire and makes the procedure costly.…”

Section: Introductionmentioning

confidence: 99%

Quantitative flow ratio vs. angiography- only guided PCI in STEMI patients: a one- year outcomes

Barauskas

Žiubrytė

Jodka

et al. 2022

Preprint

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BackgroundCoronary physiology-guided PCIs are recommended worldwide. However, invasive coronary physiology methods prolong the procedure, make additional risks for the patients, and prolong the uoroscopy time for an interventional cardiologist. Otherwise, there is a non-invasive coronary physiology evaluation method QFR, which can be safely used even in STEMI patients. Methods 198 patients admitted with STEMI and at least one intermediate (35-75%) diameter stenosis other than culprit artery between July 2020 and June 2021 have been prospectively included in this single-centre study. All patients were randomized into one of two groups (1 -QFR-guided PCI; 2 -visual-estimation-only guided PCI). A 12-month follow-up with echocardiography, exercise stress test, and quality of life evaluation was performed in all included patients. For the QOF evaluation, the Seattle angina score questionnaire was chosen. Statistical analysis was performed using Kolmogorov-Smirnov, Stjudent T, Mann-Whitney, Pearson Chi-square tests and Kaplan Meier survival analysis.Results 98 (49.5%) patients were randomized to the rst group, and 100 (50.5%) patients were included in the second group. Statistically, signi cantly more patients had a medical history of dyslipidaemia (98 vs 91, p = 0.002) and slightly better left ventricular ejection fraction (42.21 ± 7.88 vs 39.45 ± 9.62, p = 0.045) in the QFR group. Six times fewer patients required non-culprit artery revascularization within 12-month FU in the QFR group (1.02% vs 6%, p = 0.047). Survival analysis proved that patients in the Angio group had more than 6-time greater risk for death within a 12-month period after MI (OR 6.23,, p = 0.006), with the highest mortality risk within the rst two months after initial treatment. ConclusionsUsing QFR in non-culprit lesions for patients with ST-elevation myocardial infarction reduces mortality rate and revascularization in 12-month follow-up and increases the patient's quality of life. Trial registrationThe study was approved by the Regional Bioethical Committee and conducted under the principles of the Helsinki Declaration and local laws and regulations.

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Agreement between nonculprit stenosis follow-up iFR and FFR after STEMI (iSTEMI substudy)

Cited by 4 publications

References 10 publications

Correlation and Relative Prognostic Value of Fractional Flow Reserve and Pd/Pa of Nonculprit Lesions in ST-Segment–Elevation Myocardial Infarction

Correlation and Relative Prognostic Value of Fractional Flow Reserve and Pd/Pa of Nonculprit Lesions in ST-Segment–Elevation Myocardial Infarction

Fractional Flow Reserve: Patient Selection and Perspectives

Quantitative flow ratio vs. angiography- only guided PCI in STEMI patients: a one- year outcomes

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