학술논문
Clinical Value of Single-Projection Angiography–Derived FFR in Noninfarct-Related Artery
Document Type
Academic Journal
Author
Kwon, Woochan; Choi, Ki Hong; Lee, Seung Hun; Hong, David; Shin, Doosup; Kim, Hyun Kuk; Park, Keun Ho; Choo, Eun Ho; Kim, Chan Joon; Kim, Min Chul; Hong, Young Joon; Ahn, Sung Gyun; Doh, Joon-Hyung; Lee, Sang Yeub; Park, Sang Don; Lee, Hyun-Jong; Kang, Min Gyu; Koh, Jin-Sin; Cho, Yun-Kyeong; Nam, Chang-Wook; Joh, Hyun Sung; Kyu Park, Taek; Yang, Jeong Hoon; Song, Young Bin; Choi, Seung-Hyuk; Jeong, Myung Ho; Gwon, Hyeon-Cheol; Hahn, Joo-Yong; Lee, Joo Myung
Source
Circulation: Cardiovascular Interventions. May 01, 2024 17(5):e013844-e013844
Subject
Language
English
ISSN
1941-7632
Abstract
BACKGROUND:: The Murray law–based quantitative flow ratio (μFR) is an emerging technique that requires only 1 projection of coronary angiography with similar accuracy to quantitative flow ratio (QFR). However, it has not been validated for the evaluation of noninfarct-related artery (non-IRA) in acute myocardial infarction (AMI) settings. Therefore, our study aimed to evaluate the diagnostic accuracy of μFR and the safety of deferring non-IRA lesions with μFR >0.80 in the setting of AMI. METHODS:: μFR and QFR were analyzed for non-IRA lesions of patients with AMI enrolled in the FRAME-AMI trial (Fractional Flow Reserve Versus Angiography-Guided Strategy for Management of Non-Infarction Related Artery Stenosis in Patients With Acute Myocardial Infarction), consisting of fractional flow reserve (FFR)–guided percutaneous coronary intervention and angiography-guided percutaneous coronary intervention groups. The diagnostic accuracy of μFR was compared with QFR and FFR. Patients were classified by the non-IRA μFR value of 0.80 as a cutoff value. The primary outcome was a vessel-oriented composite outcome, a composite of cardiac death, non-IRA–related myocardial infarction, and non-IRA–related repeat revascularization. RESULTS:: μFR and QFR analyses were feasible in 443 patients (552 lesions). μFR showed acceptable correlation with FFR (R=0.777; P<0.001), comparable C-index with QFR to predict FFR ≤0.80 (μFR versus QFR: 0.926 versus 0.961, P=0.070), and shorter total analysis time (mean, 32.7 versus 186.9 s; P<0.001). Non-IRA with μFR >0.80 and deferred percutaneous coronary intervention had a significantly lower risk of vessel-oriented composite outcome than non-IRA with performed percutaneous coronary intervention (3.4% versus 10.5%; hazard ratio, 0.37 [95% CI, 0.14–0.99]; P=0.048). CONCLUSIONS:: In patients with multivessel AMI, μFR of non-IRA showed acceptable diagnostic accuracy comparable to that of QFR to predict FFR ≤0.80. Deferred non-IRA with μFR >0.80 showed a lower risk of vessel-oriented composite outcome than revascularized non-IRA. REGISTRATION:: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02715518.