Clinical Implication of Quantitative Flow Ratio After Percutaneous Coronary Intervention for 3-Vessel Disease

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Kogame, Norihiro ^{[1, 2]} ; Takahashi, Kuniaki ^[1] ; Tomaniak, Mariusz ^{[3, 4]} ; Chichareon, Ply ^[1] ; Modolo, Rodrigo ^[1] ; Chang, Chun Chin ^[4] ; Komiyama, Hidenori ^[1] ; Katagiri, Yuki ^[1] ; Asano, Taku ^[1] ; Stables, Rod ^[5] ; Fath-Ordoubadi, Farzin ^[6] ; Walsh, Simon ^[7] ; Sabate, Manel ^[8] ; Davies, Justin E. ^[9] ; Piek, Jan. J. ^[1] ; van Geuns, Robert-Jan ^{[4, 10]} ; Reiber, Johan H. C. ^[11] ; Banning, Adrian P. ^[12] ; Escaned, Javier ^{[13, 14]} ; Farooq, Vasim ^[15] ; Serruys, Patrick W. ^[16] ; Onuma, Yoshinobu ^[4]

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^[1] Univ Amsterdam, Med Ctr, Dept Cardiol, Amsterdam - Netherlands

^[2] Toho Univ, Med Ctr, Ohashi Hosp, Dept Cardiol, Tokyo - Japan

^[3] Med Univ Warsaw, Dept Cardiol 1, Warsaw - Poland

^[4] Erasmus MC, Ctr Thorax, Dept Intervent Cardiol, Rotterdam - Netherlands

^[5] Liverpool Heart & Chest Hosp NHS Fdn Trust, Inst Cardiovasc Med & Sci, Liverpool, Merseyside - England

^[6] Manchester Univ Fdn Trusts, Manchester Royal Infirm, Manchester Heart Ctr, Manchester, Lancs - England

^[7] Royal Victoria Hosp, Dept Cardiol, Belfast, Antrim - North Ireland

^[8] Univ Clin Hosp, Inst Invest Biorned August Pi & Sunyer, Intervent Cardiol Dept, Cardiovasc Inst, Barcelona - Spain

^[9] Imperial Coll London, Royal Brompton Hosp, London - England

^[10] Radboud UMC, Dept Cardiol, Nijmegen - Netherlands

^[11] Leiden Univ, Med Ctr, Dept Radiol, Leiden - Netherlands

^[12] John Radcliffe Hosp, Dept Cardiol, Cardiol, Oxford - England

^[13] Univ Complutense Madrid, Madrid - Spain

^[14] Hosp Clin San Carlos, Inst Invest Sanitaria San Carlos, Dept Cardiol, Madrid - Spain

^[15] Univ Hosp Wales, Dept Cardiol, Cardiff, S Glam - Wales

^[16] Imperial Coll London, Int Ctr Circulatory Hlth, London - England

• Tipo de documento: Artigo Científico
• Fonte: JACC-CARDIOVASCULAR INTERVENTIONS; v. 12, n. 20, p. 2064-2075, OCT 28 2019.
• Citações Web of Science: 0

Resumo

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-the-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-PCIQFR was analyzable in 771 (79.6%) vessels. A total of 52 (6.7%) VOCEs occurredat 2 years. The mean value of post-PCIQFR 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-PCIQFR<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. (C) 2019 by the American College of Cardiology Foundation. (AU)

• Processo FAPESP: 17/22013-8 - Impacto da complexidade coronariana sobre a mortalidade e eventos cardiovasculares de pacientes com infarto agudo do miocárdio em diferentes regimes de tratamento antiplaquetário
• Beneficiário: Rodrigo Gimenez Pissutti Modolo
• Modalidade de apoio: Bolsas no Exterior - Pesquisa