Correlation and Relative Prognostic Value of Fractional Flow Reserve and Pd/Pa of Nonculprit Lesions in ST-Segment–Elevation Myocardial Infarction. (February 2022)

• Record Type: Journal Article
• Authors: Piróth, Zsolt; Fülöp, Gábor; Boxma-de Klerk, Bianca M.; Abdelghani, Mohammad; Omerovic, Elmir; Andréka, Péter; Fontos, Géza; Neumann, Franz-Josef; Richardt, Gert; Smits, Pieter C.
• Is Part Of: Circulation. Volume 15:Number 2(2022)
• Publication Date: 2022-02
• Subjects: arteries -- fractional flow reserve -- percutaneous coronary intervention -- prognosis -- ST elevation myocardial infarction; Cardiovascular system -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Treatment -- Periodicals; 616.105
• DOI: 10.1161/CIRCINTERVENTIONS.121.010796
• Languages: English
• ISSNs: 1941-7640

Abstract

Abstract : Background: The applicability of resting indices to guide noninfarct-related artery revascularization in ST-elevation myocardial infarction is unknown. Methods: We analyzed the correlation and prognostic value of fractional flow reserve (FFR) and resting distal coronary to aortic pressure ratio (Pd/Pa) in all patients of the Compare-Acute trial in whom, after successful primary percutaneous coronary intervention, the noninfarct-related artery was interrogated by both and treated medically. The treating cardiologist was blinded to these values. The primary end point was the composite of target vessel (interrogated noninfarct-related artery) related nonfatal target vessel myocardial infarction and target vessel repeat revascularization at 36 months. Results: Five hundred seventeen patients (665 vessels) were included. On receiver-operating characteristic analysis, the optimal Pd/Pa cut off for FFR⩽0.80 was 0.905 ( C statistic: 0.894). The diagnostic accuracy of Pd/Pa was 80.15% (95% CI, 76.91%–83.12%) with respect to FFR. During the 36-month follow-up, 130 target vessel revascularization and 14 target vessel myocardial infarction occurred. FFR and Pd/Pa had a diagnostic accuracy to predict these events of 62.86% (95% CI, 59.06%–66.54%) and 56.84% (95% CI, 52.98%–60.64%), respectively ( P =0.20). When they were discrepant, FFR was significantly better than Pd/Pa in identifying which vessels could be safely deferred ( P =0.048). Conclusions: Immediately after successful primary percutaneous coronary intervention, resting Pd/Pa has a diagnostic accuracy of 80% with respect to FFR measured in the noninfarct-related artery. FFR is not significantly superior in predicting target vessel myocardial infarction and target vessel revascularization during 36 months of follow-up but, in case FFR and Pd/Pa are discrepant, FFR is superior in identifying which nonculprit vessels can be safely deferred. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01399736. Abstract : Supplemental Digital Content is available in the text.