Clinical outcomes guided by quantitative flow ratio in multivessel disease and ST-elevation myocardial infarction patients with diabetes mellitus

Abstract

Background Quantitative flow ratio (QFR) had good feasibility and accuracy in assessing the hemodynamisc compared with fraction flow reservation (FFR) as the reference. Diabetes mellitus (DM) worsens the prognosis of multivessel disease and ST-elevation myocardial infarction (MVD-STEMI) patients. However, the role of QFR in MVD-STEMI patients with DM is unknown. The purpose of this study is to investigate the clinical outcomes of patients with MVD-STEMI under different diabetes status and revascularization assignment guided by quantitative flow ratio (QFR). Methods A total 724 patients were enrolled in our study and allocated into nondiabetes mellitus (nonDM) cohort and DM cohort. Under the guidance of QFR, cohorts are divided into functional complete revascularization (FCR) layering and functional incomplete revascularization (FIR) layering. The primary outcome was a composite of major adverse cardiovascular events (MACE) including cardiac death, ischemia-driven revascularization (target vessel revascularization and nontarget vessel revascularization), rehospitalization due to unstable angina pectoris, and nonfatal myocardial infarction at 3-year follow up. Results DM cohort (22.9% vs 13.6%, P = 0.002) and FIR layering (24.0% vs 12.6%, P < 0.001) were more prone to MACE. The incidence of MACE in four groups were as follows: 27.9% DM + FIR > 18.5% nonDM + FIR > 16.1% DM + FCR > 9.8% nonDM + FCR. Besides, DM and FIR had been proven to be important predictors of MACE after adjustment for baseline clinical differences (HR = 1.60, 95%CI = 1.03–2.49, P = 0.036; HR = 1.71, 95%CI = 1.13–2.57, P = 0.011). By incorporating QFR-guided residual SYNTAX score (rSSQFR) into model of clinical risk factors, the predictive ability of the model for MACE was significantly improved, especially in the DM (+ IR) population (AUC = 0.812, 95%CI = 0.750–0.874) vs AUC = 0.666, 95%CI = 0.581–0.751, P < 0.001). Conclusions Diatebes status and functional incomplete revascularization strategy increased 3-year rates of MACE in patients with MVD-STEMI. The use of QFR by DM population is more valuable than that of nonDM population.