Author + information
- Received April 10, 2019
- Revision received August 6, 2019
- Accepted August 7, 2019
- Published online September 25, 2019.
- Norihiro Kogame, MDa,b@KogameNorihiro,
- Kuniaki Takahashi, MDa,
- Mariusz Tomaniak, MDc,d,
- Ply Chichareon, MDa,
- Rodrigo Modolo, MDa,
- Chun Chin Chang, MDc,
- Hidenori Komiyama, MDa,
- Yuki Katagiri, MDa,
- Taku Asano, MDa,
- Rod Stables, MDe,
- Farzin Fath-Ordoubadi, MDf,
- Simon Walsh, MDg,
- Manel Sabaté, MD, PhDh,
- Justin Davies, MBBS, PhDi,
- Jan.J. Piek, MD, PhDa,
- Robert-Jan van Geuns, MD, PhDc,j,
- Johan H.C. Reiber, PhDk,
- Adrian P. Banning, MBBS, MDl,
- Javier Escaned, MD, PhDm,
- Vasim Farooq, MBChB, PhDn,
- Patrick W. Serruys, MD, PhDo,∗ ( and )
- Yoshinobu Onuma, MD, PhDc
- aDepartment of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
- bDepartment of Cardiology, Toho University medical center Ohashi hospital, Tokyo, Japan
- cDepartment of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
- dFirst Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- eInstitute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
- fManchester Heart Centre, Manchester Royal Infirmary, Manchester University Foundation Trusts, Manchester, United Kingdom
- gDepartment of Cardiology, Royal Victoria Hospital, Belfast, Northern Ireland
- hInterventional Cardiology Department, Cardiovascular Institute, University Clinic Hospital, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- iRoyal Brompton Hospital, Imperial College London, London, United Kingdom
- jCardiology Department, Radboud UMC, Nijmegen, the Netherlands
- kDepartment of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- lDepartment of Cardiology, John Radcliffe Hospital, Cardiology, Oxford, United Kingdom
- mDepartment of Cardiology, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos and Universidad Complutense de Madrid, Madrid, Spain
- nDepartment of Cardiology, University Hospital Wales, Cardiff, United Kingdom
- oInternational Centre for Circulatory Health, Imperial College London, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Patrick W. Serruys, P.O. Box 2125, 3000 CC Rotterdam, the Netherlands.
Objectives The aim of this study was to investigate the impact of post–percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) on clinical outcomes in patients with de novo 3-vessel disease (3VD) treated with contemporary PCI.
Background The clinical impact of post-PCI QFR in patients treated with state-of-art PCI for de novo 3VD is undetermined.
Methods All vessels treated in the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) II trial were retrospectively screened and analyzed for post-PCI QFR. The primary endpoint of this substudy was vessel-oriented composite endpoint (VOCE) at 2 years, defined as the composite of vessel-related cardiac death, vessel-related myocardial infarction, and target vessel revascularization. The receiver-operating characteristic curve was used to calculate the optimal cutoff value of post-PCI QFR for predicting 2-year VOCE. All the analyzable vessels were stratified on the basis of the optimal cutoff value.
Results A total of 968 vessels treated with PCI were screened. Post-PCI QFR was analyzable in 771 (79.6%) vessels. A total of 52 (6.7%) VOCEs occurred at 2 years. The mean value of post-PCI QFR was 0.91 ± 0.07. The diagnostic performance of post-PCI QFR to predict 2-year VOCE was moderate (area under the curve: 0.702; 95% confidence interval: 0.633 to 0.772), with the optimal cutoff value of post-PCI QFR for predicting 2-year VOCE 0.91 (sensitivity 0.652, specificity 0.635). The incidence of 2-year VOCE in the vessels with post-PCI QFR <0.91 (n = 284) was significantly higher compared with vessels with post-PCI QFR ≥0.91 (n = 487) (12.0% vs. 3.7%; hazard ratio: 3.37; 95% confidence interval: 1.91 to 5.97; p < 0.001).
Conclusions A higher post-PCI QFR value is associated with improved vessel-related clinical outcomes in state-of-the art PCI practice for de novo 3VD. Achieving a post-PCI QFR value ≥0.91 in all treated vessels should be a target when treating de novo 3VD. These findings require confirmation in future prospective trials.
The SYNTAX II trial was an investigator-initiated study, sponsored by the European Cardiovascular Research Institute (ECRI, Rotterdam, the Netherlands) with unrestricted research grants from Volcano and Boston Scientific. The grant givers were not involved in the study design, data collection, data interpretation or writing of the manuscript. Dr. Modolo was supported by the Sao Paulo Research Foundation (Grant No. 2017/22013-8). Dr. Banning was partially funded by the National Health Service National Institute for Health Research Biomedical Research Center Oxford. Dr. Modolo has received research grant support from Biosensors. Dr. Walsh has served as a consultant to Abbott Vascular, Boston Scientific, Medtronic, and Teleflex; and received research funding from Boston Scientific. Dr. Sabaté has received personal fees from Abbott Vascular and Ivascular. Dr. Piek has served as a consultant for Philips/Volcano; and has served on the advisory board for and received travel fees from Abbott Vascular and Philips/Volcano. Dr. Banning has received lecture fees and grant support from Boston Scientific. Dr. Escaned has served as a consultant for Abbott, Philips/Volcano, and Boston Scientific. Dr. Serruys has served as a consultant for Volcano and on the advisory board for Abbott Vascular. Dr. Onuma has served on the advisory board of Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 10, 2019.
- Revision received August 6, 2019.
- Accepted August 7, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.