| BackgroundThe potential impact of quantitative flow ratio(QFR)based functional SYNTAX score(FSSQFR)on prognostication and revascularization strategy choice has not been fully investigated,and the discriminant ability of FSSQFR needs further validation.MethodsQFR was retrospectively analyzed in left main(LM)or multivessel coronary artery disease(CAD)patients from the PANDA Ⅲ trial(NCT02017275).A total of 607 patients with analyzable QFR in all vessels were included.FSSQFR was counted by summing the individual scores only in ischemia-producing lesions(vessel QFR ≤0.80).Patients were stratified according to tertiles of SYNTAX score(SS)and three groups of FSSQFR were divided by the same cutoff score.The primary endpoint was 2-year major adverse cardiac events(MACE,a composite of cardiac death,any myocardial infarction,or ischemiadriven revascularization).ResultsAfter calculating the FSSQFR,16%(96/607)of study patients moved from higher-risk group by SS to lower-risk group.In the low,intermediate,and high FSSQFR group,the cumulative incidence of 2-year MACE was 9.1%,13.5%,and 22.3%(P=0.0004),and the rate of a composite of cardiac death or myocardial infarction(3.8%,7.3%,and 13.7%,P=0.0006)was also increased.Compared with SS,FSSQFR significantly improved risk classification and prognostication(area under the curve of the receiver-operating characteristics 0.65 vs.0.62,P=0.0009.Moreover,21%(38/178)of patients,for whom CABG would be recommended according to SS,converted to favor PCI after FSSQFR calculation.After multivariate adjustment,FSSQFR was an independent predictor of 2-year MACE(adjusted hazard ratio 1.05[95%CI:1.02-1.07];P=0.0001).ConclusionsAmong patients with LM or multivessel CAD,FSSQFR showed applicability in prognostication and revascularization strategy choice.An improved scoring system combining anatomy and physiology(FSSQFR)discriminated the risk of adverse events modestly better than anatomic assessment(SS)alone.Clinical Trial Registration Information URL:https://www.clinicaltrials.gov;Unique identifier:NCT02017275.BackroundQuantitative flow ratio(QFR)is a novel angiography-based physiological index for fast computation of fractional flow reserve without use of pressure wire or induction of hyperemia.We sought to investigate the prevalence and prognostic implications of achieving physiology-concordant percutaneous coronary intervention(PCI)according to the baseline angiographic QFR in an all-comers cohort.MethodsQFR was retrospectively analyzed from the angiograms of 1,391 patients enrolled in the randomized PANDA Ⅲ trial(NCT02017275).Patients in whom all functionally ischemic vessels(baseline QFR ≤0.80)were treated and in whom all non-ischemic vessels(baseline QFR>0.80)were deferred were termed to have had QFR-concordant treatment;otherwise they were termed to have QFR-non-concordant treatment.Confounding due to differences in baseline characteristics was addressed using two propensity analysis methods(inverse probability of treatment weighting and propensity score matching).The major outcome was 2-year major adverse cardiac events(MACE,composite of all-cause death,all MI,or any ischemia-driven revascularization).ResultsOverall,814(58.5%)patients had QFR-concordant PCI,while 577(41.5%)patients received QFR-non-concordant PCI.Patients with QFR-concordant vs.those with QFRnon-concordant treatment had a lower risk of 2-year MACE(8.4%vs.14.7%;hazard ratio[HR]0.56[95%CI,0.41-0.78]).After adjusting for differences in baseline covariates,2year rates of MACE remained significantly lower in the QFR-concordant group(8.8%vs.13.6%;adjusted HR 0.64[95%CI,0.44-0.93]),mainly due to reduced ischemia-driven revascularization(2.9%vs.8.0%;adjusted HR 0.35[95%CI,0.20-0.60]).ConclusionsIn this post hoc analysis of an all-comers PCI trial,approximately 60%of patients were treated in accordance with what QFR measurement would have recommended,the achievement of which was associated with improved 2-year clinical outcomes.Clinical Trial Registration Information URL:https://www.clinicaltrials.gov;Unique identifier:NCT02017275.BackgroundThe simulated residual quantitative flow ratio(QFR)computed from pre-intervention three-dimensional coronary angiograms,which could theoretically predict actual postpercutaneous coronary intervention(PCI)QFR value,can be used for enhanced PCI via augmented reality.The study sought to investigate the concordance between simulated residual QFR and actual post-PCI QFR,and the prognostic value of simulated residual QFR.MethodsQFR assessment was retrospectively performed in treated vessels from the all-comers PANDA Ⅲ trial.Three-step analysis was performed:1)concordance between simulated residual QFR and post-PCI QFR;2)prognostic value of simulated residual QFR;and 3)forecast of outcomes by virtual randomized controlled trials(RCTs)between residual QFR and angiographic guidance.ResultsOf 2,989 treated vessels,2,146(71.8%)with paired analyzable simulated residual QFR and post-PCI QFR were included.The simulated residual QFR and post-PCI QFR were strongly correlated(r=0.976).Low simulated residual QFR(≤0.92)was independently associated with higher risk of 2-year vessel-oriented composite endpoint(adjusted hazard ratio:5.50;95%confidence interval:3.03 to 10.0).Based upon 5,000 iterations of virtual RCTs,simulated residual QFR-guided strategy was anticipated to have a 2.6%absolute reduction of 2-year incidence of target vessel failure compared with the angiographyguided strategy.ConclusionsWith high consistency to actual post-PCI QFR,the simulated residual QFR computed from pre-PCI 3-D coronary angiograms and augmented reality could predict functional outcome of the procedure and 2-year prognosis.Using data from PANDA Ⅲ trial,the present study forecasted superiority of residual QFR-guided PCI strategy over angiographic guidance.Clinical Trial Registration Information URL:https://www.clinicaltrials.gov;Unique identifier:NCT02017275.BackgroundFunctional complete revascularization(FCR)after percutaneous coronary intervention(PCI)as determined by the residual functional SYNTAX score(rFSS)based on pressure wire fractional flow reserve assessment has been associated with an improved prognosis.We sought to determine the rates and clinical implications of FCR as assessed by the quantitative flow ratio(QFR),and to determine the outcomes of pre-PCI QFR guidance compared with standard angiography guidance in patients achieving and not achieving FCR after PCI.MethodsIn the randomized,sham-controlled,blinded,multicenter FAVOR Ⅲ China trial,QFRguided PCI reduced the 1-year rate of major adverse cardiac events(MACE)compared with angiography-guided PCI.From the post-procedure angiograms,the anatomic residual SYNTAX score(rSS)was determined using an online calculator based on a specific scoring algorithm.The rFSS were calculated by summing only the individual rSS of lesions with post-PCI QFR ≤0.80.FCR was defined as a rFSS=0.In the present pre-specified substudy,the incidence of MACE was compared according to the presence of post-PCI FCR(rFSS=0 based on core laboratory-assessed QFR)in the QFR-guided and angiographyguided groups.ResultsAmong 3,781 patients with available rFSS assessments,3,221(85.2%)achieved FCR,including 88.1%after QFR guidance and 82.2%after angiography guidance(P<0.001).Patients with FCR had a markedly lower rate of 1-year MACE compared with those with functional incomplete revascularization(FIR;rFSS≥1)(5.1%vs.19.7%,P<0.001).Prognostic models including the rFSS had higher discrimination and reclassification ability than those with the anatomic rSS.The relative risks for 1-year MACE with QFR-guided compared with the angiography-guided lesion selection were consistent in patients achieving FCR(4.1%vs.6.3%;HR 0.65,95%CI:0.47-0.88)and in those with FIR(18.7%vs.20.4%;HR 0.90,95%CI:0.61-1.32)(Pinteraction=0.19).ConclusionsIn this large-scale trial,achieving FCR after PCI was associated with markedly lower 1year rates of MACE.Compared with standard angiography guidance,QFR-guided PCI lesion selection improved the likelihood of achieving FCR and improved 1-year clinical outcomes in patients with both FCR and FIR.Clinical Trial Registration Information URL:https://www.clinicaltrials.gov;Unique identifier:NCT03656848. |
PDF Full Text Request