Clinical relevance and prognostic implications of contrast quantitative flow ratio in patients with coronary artery disease. (15th February 2021)

• Record Type: Journal Article
• Authors: Choi, Ki Hong; Lee, Seung Hun; Lee, Joo Myung; Hwang, Doyeon; Zhang, Jinlong; Kim, Jihoon; Im, Se Young; Kim, Hyun Kuk; Nam, Chang-Wook; Doh, Joon-Hyung; Shin, Eun-Seok; Mejía-Rentería, Hernán; Park, Taek Kyu; Yang, Jeong Hoon; Song, Young Bin; Hahn, Joo-Yong; Choi, Seung-Hyuk; Gwon, Hyeon-Cheol; Escaned, Javier; Koo, Bon-Kwon
• Is Part Of: International journal of cardiology. Volume 325(2021)
• Page Start: 23
• Page End: 29
• Publication Date: 2021-02-15
• Subjects: Fractional flow reserve -- Quantitative flow ratio -- Quantitative coronary angiography -- Outcomes -- Prognosis; ACS acute coronary syndrome -- FFR fractional flow reserve -- iFR instantaneous wave-free ratio -- IHD ischemic heart disease -- MI myocardial infarction -- PCI percutaneous coronary intervention -- QCA quantitative coronary angiography -- QFR quantitative flow ratio -- TLR target lesion revascularization -- VOCO vessel-oriented composite outcome; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.09.002
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: We sought to evaluate the diagnostic performance of contrast quantitative flow ratio (cQFR) in all-comer patients with coronary artery disease, and to compare the vessel-oriented composite outcomes (VOCO) according to cQFR values. Method: 599 vessels with 452 patients who underwent clinically indicated fractional flow reserve (FFR) and cQFR measurement were evaluated. The cQFR, derived from 3-dimensional quantitative coronary angiography combined with TIMI frame-counts was compared with FFR as a reference standard. The risk of VOCO at 2 years, a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target lesion revascularization, was compared according to cQFR and FFR value. Results: cQFR strongly correlated with FFR (r=0.860, p<0.001) and showed diagnostic accuracy of 91.2% to predict FFR≤0.80. cQFR showed significantly higher c-index to predict FFR≤0.80 (0.953, 95%CI 0.937-0.969) than %DS, percent area stenosis, resting distal coronary pressure/aortic pressure, and fixed QFR (p<0.001). Diagnostic accuracy of cQFR was not different according to various subgroups including non-culprit vessel of acute coronary syndrome and diabetes mellitus. Vessels with low cQFR (≤0.80) showed a significantly higher risk of VOCO at 2-year compared to those with high cQFR (>0.80) (HR 4.650, 95%CI 1.254-17.240, p=0.022). Discriminatory ability of cQFR for VOCO was similar with that of FFR (0.672 vs. 0.643, p=0.147). Conclusion: cQFR showed excellent correlation and diagnostic accuracy with FFR in diverse clinical presentations or patient characteristics. Low cQFR was significantly associated with a higher risk of VOCO at 2 years compared with high cQFR and cQFR showed similar discriminatory ability for VOCO with FFR. Highlights: Contrast quantitative flow ratio (cQFR) showed excellent diagnostic performance with fractional flow reserve (FFR). Vessels with low cQFR was associated with significantly higher risks of vessel oriented composite outcome (VOCO) than those with high cQFR. On this basis, cQFR might be a reasonable option for functional assessment of coronary stenosis regardless of clinical presentation or characteristics.