Prognostic Value of Postpercutaneous Coronary Intervention Murray-Law-Based Quantitative Flow Ratio
Daixin Ding, Jinlong Zhang, Peng Wu, Zhiqing Wang, Huiping Shi, Wei Yu, Xinyang Hu, Jeehoon Kang, Joo‐Yong Hahn, Chang‐Wook Nam, Joon‐Hyung Doh, Bong‐Ki Lee, Weon Kim, Jinyu Huang, Fan Jiang, Hao Zhou, Peng Chen, Lijiang Tang, Wenbing Jiang, Xiao Dong Chen, Wenming He, Sung Gyun Ahn, Myeong‐Ho Yoon, Ung Kim, You‐Jeong Ki, Eun‐Seok Shin, Seung‐Jea Tahk, Jun Pu, William Wijns, Jianan Wang, Bon‐Kwon Koo, Shengxian Tu
Abstract
Background: Coronary physiology measured by fractional flow reserve (FFR) is superior to angiography for assessing the efficacy of percutaneous coronary intervention (PCI). Yet, the clinical adoption of post-PCI FFR is limited. Murray law-based quantitative flow ratio (μQFR) may represent a promising alternative, as it can quickly compute FFR from a single angiographic view. Objectives: The authors aimed to investigate the potential role of post-PCI μQFR in predicting clinical outcomes. Methods: This was a post hoc blinded analysis of the FLAVOUR trial. Patients with angiographically intermediate lesions randomized 1:1 to receive FFR or intravascular ultrasound-guided PCI were included. Post-PCI μQFR was assessed in successfully stented vessels, blinded to clinical outcomes. Suboptimal physiological outcome post-PCI was defined a priori as post-PCI μQFR <0.90. The primary endpoint was 2-year target vessel failure, including cardiac death, target vessel myocardial infarction, and target vessel revascularization. Secondary endpoints included the diagnostic concordance of pre-PCI μQFR with FFR in the FFR-guidance arm. Results: 0.022). Pre-PCI μQFR was obtained in 877 of 919 vessels (feasibility 95.4%), showing 90% accuracy, 82% sensitivity, and 94% specificity for identifying physiologically significant stenosis defined by pre-PCI FFR ≤0.80. Conclusions: In patients with intermediate lesions who underwent PCI with contemporary imaging or physiology guidance, lower post-PCI μQFR values predict subsequent adverse events. (Fractional FLow Reserve And IVUS for Clinical OUtcomes in Patients With InteRmediate Stenosis [FLAVOUR]; NCT02673424).