Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w

Prognostic impact of QFR-consistency for PCI strategy in patients with acute coronary syndrome

A. Erbay1, L. Penzel2, Y. Abdelwahed2, J. Klotsche3, A. Heuberger2, A.-S. Schatz2, C. Seppelt2, J. Steiner2, A. Haghikia2, U. Landmesser2, B. Stähli4, D. Leistner1

1Med. Klinik III - Kardiologie, Angiologie, Universitätsklinikum Frankfurt, Frankfurt am Main; 2CC 11: Med. Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Berlin; 3Deutsches Rheumaforschungszentrum Berlin, Berlin; 4Universitäres Herzzentrum, UniversitätsSpital Zürich, Zürich, CH;

Background: Functionally guided complete coronary revascularization in patients with acute coronary syndrome (ACS) is associated with prognostically better outcome and has been demonstrated in several studies for invasively assessed fractional flow reserve (FFR). Quantitative flow ratio (QFR) represents an angiography-based functional tool for fast hemodynamic assessment using three-dimensional remodelling and computational flow algorithms. Aims: The present study investigated for the first time the prognostic impact of QFR-consistent percutaneous coronary intervention (PCI) of non-culprit lesions (NCL) in patients with ACS. Methods: A total of 792 patients with ACS who underwent primary PCI of the ACS-causing culprit lesion were enrolled in the analysis. Post-hoc QFR analyses of 1320 non-culprit vessels were performed by investigators blinded to clinical outcome. Major adverse cardiovascular events (MACE), including all-cause mortality, non-fatal myocardial infarction, and ischemia-driven coronary revascularization within two years after the index ACS event were assessed. Patients were stratified into QFR-consistent and QFR-inconsistent PCI groups according to their QFR-results for non-culprit vessels. Group 1 “QFR-consistent PCI” consists of patients in whom all NCL with QFR ≤0.80 were treated by PCI at time of ACS or planned staged procedure and none of the NCL with QFR >0.80 were treated. The second group “QFR-inconsistent PCI” comprises patients with at least one revascularized non-culprit vessel with QFR >0.80 or at least one vessel with NCL QFR ≤0.80 which was not treated. Results: The QFR-consistent PCI group comprised 646 patients, while the QFR-inconsistent PCI group included 146 patients. Patients with QFR-inconsistent PCI had a significantly higher risk for MACE (18.5% vs. 3.4%; hazard ratio (HR) 5.94, 95% confidence interval (CI) 3.38-10.43; p<0.001) mainly driven by non-fatal myocardial infarction (15.1% vs. 2.0%; HR 8.09, 95% CI 4.08-16.06; p<0.001) and ischemia-driven revascularization (5.5% vs. 1.2%; HR 4.82, 95% CI 1.81-12.84; p=0.001). Conclusions: The present study for the first time demonstrates a prognostic impact of QFR-consistent PCI of non-culprit lesions on clinical outcomes in patients with ACS and underlines the value of angiography-based functional assessment for personalized risk stratification and revascularization strategy in patients with ACS.

https://dgk.org/kongress_programme/jt2023/aP881.html