Author + information
- Received June 11, 2018
- Revision received September 3, 2018
- Accepted September 17, 2018
- Published online February 4, 2019.
- Taku Asano, MDa,b,
- Yuki Katagiri, MDa,
- Chun Chin Chang, MDc,
- Norihiro Kogame, MDa,
- Ply Chichareon, MDa,
- Kuniaki Takahashi, MDa,
- Rodrigo Modolo, MDa,
- Erhan Tenekecioglu, MDc,
- Carlos Collet, MDa,d,
- Hans Jonker, BSce,
- Clare Appleby, MDf,
- Azfar Zaman, MDg,
- Nicolas van Mieghem, MD, PhDc,
- Neal Uren, MDh,
- Javier Zueco, MDi,
- Jan J. Piek, MD, PhDa,
- Johan H.C. Reiber, MD, PhDj,
- Vasim Farooq, MD, PhDk,
- Javier Escaned, MD, PhDl,
- Adrian P. Banning, MDm,
- Patrick W. Serruys, MD, PhDc,∗ ( and )
- Yoshinobu Onuma, MD, PhDc,f
- aDepartment of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- bDepartment of Cardiology, St. Luke’s International Hospital, Tokyo, Japan
- cThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands
- dDepartment of Cardiology, Universitair Ziekenhuis Brussels, Brussels, Belgium
- eCardialysis, Rotterdam, the Netherlands
- fDepartment of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- gDepartment of Cardiology, Freeman Hospital Newcastle, Newcastle upon Tyne, United Kingdom
- hDepartment of Cardiology, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- iDepartment of Cardiology, Hospital Universitario Valdecilla, Cantabria, Spain
- jDepartment of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- kManchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, United Kingdom
- lHospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
- mDepartment of Cardiology, John Radcliffe Hospital, Cardiology, Oxford, United Kingdom
- ↵∗Address for correspondence:
Prof. Patrick W. Serruys, ThoraxCenter, Erasmus Medical Center, Westblaak 98, 3012 KM Rotterdam, the Netherlands.
Objectives The aims of the present study were to investigate the applicability of quantitative flow ratio (QFR) in patients with 3-vessel disease and to demonstrate the impact of functional SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score derived from QFR (fSSQFR) on clinical outcomes.
Background The applicability of QFR in patients with 3-vessel disease and the feasibility of fSSQFR have not yet been investigated.
Methods All lesions interrogated using instantaneous wave-free ratio and/or fractional flow reserve in the SYNTAX II trial were retrospectively screened and analyzed for QFR. The diagnostic performance of QFR was investigated using hybrid wire-derived pressure assessment (instantaneous wave-free ratio and fractional flow reserve), used in the trial as a reference. Patients with analyzable QFR in 3 vessels were stratified according to fSSQFR to evaluate its clinical prognostic value on the basis of 2-year patient-oriented composite endpoint.
Results QFRs were analyzable in 71.0% of lesions (836 lesions). The diagnostic performance of QFR to predict binary wire-based ischemia was substantial (area under the curve 0.81, accuracy 73.8%), with a positive predictive value of 85.9%. Independent predictors of diagnostic discordance were lesions in side branches, involvement of bifurcation or trifurcation, and small vessel. According to the 2-year patient-oriented composite endpoint, fSSQFR reclassified 26.1% of the patients (36 of 138) in the high- to intermediate-risk group into the low-risk group appropriately (net reclassification improvement 0.32; p < 0.001). The area under the curve for fSSQFR to predict the 2-year patient-oriented composite endpoint was higher than that of the classic anatomic SYNTAX score (0.68 vs. 0.56; p = 0.002).
Conclusions QFR demonstrated substantial applicability in patients with 3-vessel disease. The fSSQFR has the potential to further refine prognostic risk estimation compared with the classic anatomic SYNTAX score.
Dr. Reiber is the CEO of Medis Medical Imaging Systems and has a part-time appointment at Leiden University Medical Center as professor of medical imaging. Dr. Escaned is a consultant for Philips/Volcano and Boston Scientific. Dr. Banning receives lecture fees and grant support from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 11, 2018.
- Revision received September 3, 2018.
- Accepted September 17, 2018.
- 2019 American College of Cardiology Foundation
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