Hospital Clinico San Carlos IDISSC and Complutense University of Madrid, Madrid, Spain.
EuroIntervention. 2020 Apr 3;15(18):e1594-e1601. doi: 10.4244/EIJ-D-18-01165.
Functional assessment of non-culprit lesions (NCL) in patients presenting with ST-elevation myocardial infarction (STEMI) and multivessel disease constitutes an unmet need. This study aimed to evaluate the diagnostic accuracy of quantitative flow ratio (QFR) in the functional assessment of NCL during the acute phase of STEMI.
This was a retrospective, observational, multicentre study including patients with STEMI and staged fractional flow reserve (FFR) assessment of NCL. QFR in NCL was calculated from the coronary angiogram acquired during primary PCI in a blinded fashion with respect to FFR. The diagnostic value of QFR in the STEMI population was compared with a propensity score-matched population of stable angina patients. Eighty-two patients (91 NCL) were included. Target lesions were of both angiographic and functional (mean FFR 0.82±0.09) intermediate severity. The diagnostic performance of QFR was high (AUC 0.91 [95% CI: 0.85-0.97]) and similar to that observed in the matched control population (AUC 0.91 vs 0.94, p=0.5). The diagnostic accuracy of QFR was very high (>95%) in those vessels (61.5%) with QFR values out of a ROC-defined "grey zone" (0.75-0.85). A hybrid FFR/QFR approach (FFR only when QFR is in the grey zone) would adequately classify 96.7% of NCL, avoiding 58.5% of repeat diagnostic procedures.
QFR has a good diagnostic accuracy in assessing the functional relevance of NCL during primary PCI, similar to the accuracy observed in stable patients.
评估 ST 段抬高型心肌梗死（STEMI）伴多支血管病变患者非罪犯病变（NCL）的功能评估是未满足的需求。本研究旨在评估定量血流比（QFR）在 STEMI 急性期评估 NCL 功能中的诊断准确性。
这是一项回顾性、观察性、多中心研究，纳入了接受 STEMI 分期血流储备分数（FFR）评估的 NCL 患者。NCL 的 QFR 是在经皮冠状动脉介入治疗（PCI）期间通过盲法从冠状动脉造影中计算出来的，与 FFR 无关。QFR 在 STEMI 人群中的诊断价值与稳定型心绞痛患者的倾向评分匹配人群进行了比较。共纳入 82 例患者（91 个 NCL）。靶病变在血管造影和功能方面均为中度严重程度（平均 FFR 0.82±0.09）。QFR 的诊断性能较高（AUC 0.91[95%CI：0.85-0.97]），与匹配对照组（AUC 0.91 与 0.94，p=0.5）相似。在 QFR 值处于 ROC 定义的“灰色区域”（0.75-0.85）的血管中（61.5%），QFR 的诊断准确性非常高（>95%）。FFR/QFR 混合方法（仅在 QFR 处于灰色区域时使用 FFR）可适当分类 96.7%的 NCL，避免 58.5%的重复诊断程序。
在经皮冠状动脉介入治疗期间，QFR 评估 NCL 的功能相关性具有良好的诊断准确性，与稳定型患者的准确性相似。
