학술논문
Quantitative flow ratio versus fractional flow reserve for Heart Team decision-making in multivessel disease: the randomised, multicentre DECISION QFR trial.
Document Type
Academic Journal
Author
Asano T; Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Tanigaki T; Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.; Hoshino M; Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.; Yasunaga M; Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.; Nonaka H; Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.; Emori H; Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.; Katagiri Y; Department of Cardiovascular Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.; Miyazaki Y; Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan.; Sotomi Y; Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.; Kogame N; Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.; Kuramitsu S; Sapporo Cardiovascular Clinic, Sapporo Heart Center, Sapporo, Japan.; Saito A; Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Miyata K; Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Takaoka Y; Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Kanie T; Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Yamasaki M; Department of Cardiovascular Surgery, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Yoshino K; Department of Cardiovascular Surgery, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Wakabayashi N; Department of Radiology, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Ouchi K; Department of Radiology, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Kodama H; Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Shiina Y; Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Tamaki R; Department of Cardiovascular Surgery, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Nishihata Y; Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Masuda K; Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Suzuki T; Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Reiber JHC; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.; Okamura T; Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan.; Higuchi Y; Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.; Kakuta T; Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.; Misumi H; Department of Cardiovascular Surgery, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Abe K; Department of Cardiovascular Surgery, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Komiyama N; Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.; Tanabe K; Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.; Matsuo H; Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.; Qfr Investigators OBOTD
Source
Publisher: Société Europa édition Country of Publication: France NLM ID: 101251040 Publication Model: Print Cited Medium: Internet ISSN: 1969-6213 (Electronic) Linking ISSN: 1774024X NLM ISO Abbreviation: EuroIntervention Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Vessel-level physiological data derived from pressure wire measurements are one of the important determinant factors in the optimal revascularisation strategy for patients with multivessel disease (MVD). However, these may result in complications and a prolonged procedure time.
Aims: The feasibility of using the quantitative flow ratio (QFR), an angiography-derived fractional flow reserve (FFR), in Heart Team discussions to determine the optimal revascularisation strategy for patients with MVD was investigated.
Methods: Two Heart Teams were randomly assigned either QFR- or FFR-based data of the included patients. They then discussed the optimal revascularisation mode (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) for each patient and made treatment recommendations. The primary endpoint of the trial was the level of agreement between the treatment recommendations of both teams as assessed using Cohen's kappa.
Results: The trial included 248 patients with MVD from 10 study sites. Cohen's kappa in the recommended revascularisation modes between the QFR and FFR approaches was 0.73 [95% confidence interval {CI} : 0.62-0.83]. As for the revascularisation planning, agreements in the target vessels for PCI and CABG were substantial for both revascularisation modes (Cohen's kappa=0.72 [95% CI: 0.66-0.78] and 0.72 [95% CI: 0.66-0.78], respectively). The team assigned to the QFR approach provided consistent recommended revascularisation modes even after being made aware of the FFR data (Cohen's kappa=0.95 [95% CI:0.90-1.00]).
Conclusions: QFR provided feasible physiological data in Heart Team discussions to determine the optimal revascularisation strategy for MVD. The QFR and FFR approaches agreed substantially in terms of treatment recommendations.
Aims: The feasibility of using the quantitative flow ratio (QFR), an angiography-derived fractional flow reserve (FFR), in Heart Team discussions to determine the optimal revascularisation strategy for patients with MVD was investigated.
Methods: Two Heart Teams were randomly assigned either QFR- or FFR-based data of the included patients. They then discussed the optimal revascularisation mode (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) for each patient and made treatment recommendations. The primary endpoint of the trial was the level of agreement between the treatment recommendations of both teams as assessed using Cohen's kappa.
Results: The trial included 248 patients with MVD from 10 study sites. Cohen's kappa in the recommended revascularisation modes between the QFR and FFR approaches was 0.73 [95% confidence interval {CI} : 0.62-0.83]. As for the revascularisation planning, agreements in the target vessels for PCI and CABG were substantial for both revascularisation modes (Cohen's kappa=0.72 [95% CI: 0.66-0.78] and 0.72 [95% CI: 0.66-0.78], respectively). The team assigned to the QFR approach provided consistent recommended revascularisation modes even after being made aware of the FFR data (Cohen's kappa=0.95 [95% CI:0.90-1.00]).
Conclusions: QFR provided feasible physiological data in Heart Team discussions to determine the optimal revascularisation strategy for MVD. The QFR and FFR approaches agreed substantially in terms of treatment recommendations.