Post-PCI outcomes predicted by pre-intervention simulation of residual quantitative flow ratio using augmented reality. (1st April 2022)

• Record Type: Journal Article
• Authors: Zhang, Rui; Xu, Bo; Dou, Kefei; Guan, Changdong; Zhao, Yanyan; Wang, Xuxia; Zou, Tongqiang; Qiao, Zheng; Xie, Lihua; Wang, Haoyu; Yuan, Sheng; Song, Lei; Tu, Shengxian; Wang, Yang; Wijns, William
• Is Part Of: International journal of cardiology. Volume 352(2022)
• Page Start: 33
• Page End: 39
• Publication Date: 2022-04-01
• Subjects: Augmented reality -- Coronary artery disease -- Percutaneous coronary intervention -- Clinical outcomes -- Physiology assessment; CAD coronary artery disease -- FFR fractional flow reserve -- iFR instantaneous wave-free ratio -- PCI percutaneous coronary intervention -- QFR quantitative flow ratio -- RCT randomized controlled trial -- TVF target vessel failure -- 3-D three-dimensional -- VOCE vessel-oriented composite endpoint; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.01.054
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The simulated residual quantitative flow ratio (QFR) computed from pre-intervention three-dimensional (3-D) coronary angiograms, which could theoretically predict actual post-percutaneous coronary intervention (PCI) QFR value, can be used for enhanced PCI via augmented reality. The study sought to investigate the concordance between simulated residual QFR and actual post-PCI QFR, and the prognostic value of simulated residual QFR. Methods: QFR assessment was retrospectively performed in treated vessels from the all-comers PANDA III trial. Three-step analysis was performed: 1) concordance between simulated residual QFR and post-PCI QFR; 2) prognostic value of simulated residual QFR; and 3) forecast of outcomes by virtual randomized controlled trials (RCTs) between residual QFR and angiographic guidance. Results: Of 2989 treated vessels, 2146 (71.8%) with paired analyzable simulated residual QFR and post-PCI QFR were included. The simulated residual QFR and post-PCI QFR were strongly correlated ( r = 0.976). Low simulated residual QFR (≤0.92) was independently associated with higher risk of 2-year vessel-oriented composite endpoint (adjusted hazard ratio: 5.50; 95% confidence interval: 3.03 to 10.0). Based upon 5000 iterations of virtual RCTs, simulated residual QFR-guided strategy was anticipated to have a 2.6% absolute reduction of 2-year incidence of target vessel failure compared with the angiography-guided strategy. Conclusions: With high consistency to actual post-PCI QFR, the simulated residual QFR computed from pre-PCI 3-D coronary angiograms and augmented reality could predict functional outcome of the procedure and 2-year prognosis. Using data from PANDA III trial, the present study forecasted superiority of residual QFR-guided PCI strategy over angiographic guidance. Clinical Trial Registration Information URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02017275 . Graphical abstract: (A) Good per-vessel agreement and correlation between simulated residual QFR and actual post-PCI QFR; (B) Suboptimal simulated residual QFR was associated with worse prognosis; (C) By 5000 times virtual randomized controlled trials, it is very likely that routine application of residual QFR would improve clinical outcomes. ID-TVR, ischemia-driven target vessel revascularization; MI, myocardial infarction; QFR, quantitative flow ratio; SD, standard deviation; TVF, target vessel failure; VOCE, vessel-oriented composite endpoint. Unlabelled Image Highlights: The simulated residual QFR computed from pre-PCI coronary angiograms could theoretically predict actual post-PCI QFR value. This study presented strong concordance between pre-PCI residual QFR and actual post-PCI QFR, and the prognostic value of residual QFR. This study supports the use of residual QFR in daily practice to further improve prognosis by help develop the best strategies while planning PCI.