Author + information
- Received April 12, 2019
- Revision received May 16, 2019
- Accepted June 4, 2019
- Published online September 25, 2019.
- Simone Biscaglia, MDa,
- Matteo Tebaldi, MDa,
- Salvatore Brugaletta, MD, PhDb,
- Enrico Cerrato, MDc,
- Andrea Erriquez, MDa,
- Giulia Passarini, MDa,
- Alfonso Ielasi, MDd,
- Giosafat Spitaleri, MDb,
- Domenico Di Girolamo, MDe,
- Giuseppe Mezzapelle, MDf,
- Salvatore Geraci, MDg,
- Marco Manfrini, PhDh,
- Rita Pavasini, MDa,
- Emanuele Barbato, MD, PhDi and
- Gianluca Campo, MDa,h,∗ ()
- aCardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
- bUniversity Hospital Clínic, Cardiovascular Clinic Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- cSan Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli, Turin, Italy
- dInterventional Cardiology Unit, S. Ambrogio Cardio-Thoracic Center, Milan, Italy
- eCardiologia Interventistica, A.O. Sant’Anna e San Sebastiano, Caserta, Italy
- fOspedale Giovanni Paolo II, Sciacca, Italy
- gInterventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
- hMaria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
- iDivision of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- ↵∗Address for correspondence:
Dr. Gianluca Campo, Cardiovascular Institute, Azienda Ospedaliera Universitaria S. Anna, Via Aldo Moro 8, 44124, Cona, Italy.
Objectives The aim of this study was to investigate the potential role of post–percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) measurements to predict clinical outcomes in patients with successful PCI.
Background The prognostic value of QFR measured immediately after PCI has not been prospectively investigated.
Methods Patients undergoing complete revascularization with successful PCI and stent implantation were eligible for acquisition of projections for QFR computation. At the end of the procedure, 2 angiographic projections for each vessel treated with PCI were acquired. Computation of QFR was performed offline by an independent core laboratory. The primary outcome was the vessel-oriented composite endpoint, defined as vessel-related cardiovascular death, vessel-related myocardial infarction, and ischemia-driven target vessel revascularization.
Results Seven hundred fifty-one vessels in 602 patients were analyzed. The median value of post-PCI QFR was 0.97 (interquartile range: 0.92 to 0.99). Lesion location in the left anterior descending coronary artery, baseline SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score, lesion length, and post-PCI diameter stenosis were found to be predictors of lower post-PCI QFR. Altogether, 77 events were detected in 53 treated vessels (7%). Post-PCI QFR was significantly lower in vessels with the vessel-oriented composite endpoint during follow-up, compared with those without it (0.88 [interquartile range: 0.81 to 0.99] vs. 0.97 [interquartile range: 0.93 to 0.99], respectively; p < 0.001). Receiver operating characteristic curve analysis identified a post-PCI QFR best cutoff of ≤0.89 (area under the curve 0.77; 95% confidence interval: 0.74 to 0.80; p < 0.001). After correction for potential confounding factors, post-PCI QFR ≤0.89 was associated with a 3-fold increase in risk for the vessel-oriented composite endpoint (hazard ratio: 2.91; 95% confidence interval: 1.63 to 5.19; p < 0.001).
Conclusions Lower values of QFR after complete and successful revascularization predict subsequent adverse events (Angio-Based Fractional Flow Reserve to Predict Adverse Events After Stent Implantation [HAWKEYE]; NCT02811796)
- angiography-based fractional flow reserve
- percutaneous coronary intervention
- quantitative flow ratio
- second-generation drug-eluting stent
- vessel-oriented composite endpoint
This study was an investigator-driven clinical trial conducted by the University of Ferrara. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 12, 2019.
- Revision received May 16, 2019.
- Accepted June 4, 2019.
- 2019 American College of Cardiology Foundation
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