Prognostic Value of Quantitative Flow Ratio Based Functional SYNTAX Score in Patients With Left Main or Multivessel Coronary Artery Disease. (October 2020)

• Record Type: Journal Article
• Authors: Zhang, Rui; Song, Chenxi; Guan, Changdong; Liu, Qianqian; Wang, Chunyue; Xie, Lihua; Sun, Zhongwei; Cai, Minsi; Zhang, Min; Wang, Huan; Liu, Jian; Dou, Kefei; Xu, Bo
• Is Part Of: Circulation. Volume 13:Number 10(2020)
• Publication Date: 2020-10
• Subjects: coronary artery disease -- incidence -- myocardial infarction -- percutaneous coronary intervention -- prognosis; Cardiovascular system -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Treatment -- Periodicals; 616.105
• DOI: 10.1161/CIRCINTERVENTIONS.120.009155
• Languages: English
• ISSNs: 1941-7640

Abstract

Abstract : Background: The potential impact of quantitative flow ratio (QFR) based functional Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (FSSQFR ) on prognostication and revascularization strategy choice has not been fully investigated, and the discriminant ability of FSSQFR needs further validation. Methods: QFR was retrospectively analyzed in left main or patients with multivessel coronary artery disease from the PANDA III trial. A total of 607 patients with analyzable QFR in all vessels were included. FSSQFR was counted by summing the individual scores only in ischemia-producing lesions (vessel QFR ⩽0.8). Patients were stratified according to tertiles of SYNTAX score (SS), and 3 groups of FSS were divided by the same cutoff score. The primary end point was 2-year major adverse cardiac events (a composite of cardiac death, any myocardial infarction, or ischemia-driven revascularization). Results: After calculating the FSSQFR, 16% (96/607) of study patients moved from higher-risk group by SS to lower-risk group. In the low, intermediate, and high FSSQFR group, the cumulative incidence of 2-year major adverse cardiac events was 9.1%, 13.5%, and 22.3% ( P =0.0004), and the rate of a composite of cardiac death or myocardial infarction (3.8%, 7.3%, and 13.7%, P =0.0006) was also increased. Compared with SS, FSSQFR significantly improved risk classification and prognostication (area under the curve of the receiver-operating characteristics 0.65 versus 0.62, P =0.0009). Moreover, 6% (38/607) of patients, for whom coronary artery bypass grafting would be recommended according to SS, converted to favor percutaneous coronary intervention after FSSQFR calculation. After multivariate adjustment, FSSQFR was an independent predictor of 2-year major adverse cardiac events (adjusted hazard ratio, 1.05 [95% CI, 1.02–1.07]; P =0.0001). Conclusions: Among patients with left main or multivessel coronary artery disease, FSSQFR showed applicability in prognostication and revascularization strategy choice. An improved scoring system combining anatomy and physiology (FSSQFR ) discriminated the risk of adverse events modestly better than anatomic assessment (SS) alone. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02017275. Abstract : Supplemental Digital Content is available in the text.