van der Eijk Jari A, Groenland Frederik T W, Scoccia Alessandra, Ziedses des Plantes Annemieke C, Huang Jager, Nuis Rutger-Jan, Wilschut Jeroen M, den Dekker Wijnand K, Diletti Roberto, Kardys Isabella, Tomaniak Mariusz, Van Mieghem Nicolas M, Daemen Joost
Department of (Interventional) Cardiology, Thoraxcenter, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Clin Res Cardiol. 2025 Sep 8. doi: 10.1007/s00392-025-02729-x.
Fractional flow reserve (FFR) for non-culprit lesions (NCLs) in patients with ST-elevation myocardial infarction (STEMI) can be influenced by temporary changes in microvascular resistance. Angiography-derived vessel fractional flow reserve (vFFR) has been tested as a less-invasive alternative.
The FAST STEMI II study aimed to assess the diagnostic performance of acute-setting vFFR vs. FFR for intermediate NCLs in STEMI patients.
FAST STEMI II is a prospective two-center cohort study including STEMI patients with ≥ 1 intermediate NCL (50-90% diameter stenosis). Patients with cardiogenic shock, prior revascularization of the non-culprit vessel, or aorta-ostial lesions were excluded. Following primary percutaneous coronary intervention (PCI), vFFR, FFR, resting full-cycle ratio (RFR), coronary flow reserve (CFR), and index of microcirculatory resistance (IMR) measurements of the NCL were performed.
A total of 111 patients were included. Median [25th-75th percentile] vFFR and FFR were 0.83 [0.74-0.88] and 0.83 [0.80-0.90], respectively. vFFR had a moderate to good discriminative ability to predict FFR ≤ 0.80 (AUC: 0.78; 95% CI: 0.68-0.89; p < 0.001) with a moderate correlation (r = 0.54; p < 0.001). Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of vFFR to predict FFR ≤ 0.80 were 72%, 76%, 70%, 53%, and 87%, respectively. Microvascular dysfunction (CFR < 2.0 and IMR ≥ 25) was observed in 33 (31%) patients. In patients with microvascular dysfunction, median vFFR and FFR values were 0.76 [0.71-0.86] and 0.85 [0.77-0.90], respectively (p = 0.002).
We found moderate correlation between vFFR and FFR in NCLs of patients undergoing primary PCI. Discordance between vFFR and FFR was associated with the presence of microvascular dysfunction. The study was conducted in accordance with Good Clinical Practice and the Declaration of Helsinki and was registered at 22-jun-2023 on clinicaltrials.gov under the identifier NCT05698719.
ST段抬高型心肌梗死（STEMI）患者非罪犯病变（NCL）的血流储备分数（FFR）可能受微血管阻力的暂时变化影响。血管造影衍生的血管血流储备分数（vFFR）已作为一种侵入性较小的替代方法进行了测试。
FAST STEMI II研究旨在评估急性情况下vFFR与FFR对STEMI患者中度NCL的诊断性能。
FAST STEMI II是一项前瞻性双中心队列研究，纳入了患有≥1个中度NCL（直径狭窄50%-90%）的STEMI患者。排除心源休克、非罪犯血管先前已血运重建或主动脉开口病变患者。在初次经皮冠状动脉介入治疗（PCI）后，对NCL进行vFFR、FFR、静息全周期比率（RFR）、冠状动脉血流储备（CFR）和微循环阻力指数（IMR）测量。
共纳入111例患者。vFFR和FFR的中位数[第25-75百分位数]分别为0.83[0.74-0.88]和0.83[0.80-0.90]。vFFR对预测FFR≤0.80具有中度至良好的判别能力（曲线下面积：0.78；95%置信区间：0.68-0.89；p<0.001），相关性中等（r=0.54；p<0.001）。vFFR预测FFR≤0.80的诊断准确性、敏感性、特异性、阳性预测值和阴性预测值分别为72%、76%、70%、53%和87%。33例（31%）患者观察到微血管功能障碍（CFR<2.0且IMR≥25）。在微血管功能障碍患者中，vFFR和FFR的中位数分别为0.76[0.71-0.86]和0.85[0.77-0.90]（p=0.002）。
我们发现接受初次PCI患者的NCL中vFFR与FFR之间存在中度相关性。vFFR与FFR之间的不一致与微血管功能障碍的存在有关。本研究按照良好临床实践和《赫尔辛基宣言》进行，并于2023年6月22日在clinicaltrials.gov上注册，标识符为NCT05698719。
