Prognostic Value of Postpercutaneous Coronary Intervention Murray-Law-Based Quantitative Flow Ratio
Background: Coronary physiology measured by fractional flow reserve (FFR) is superior to angiography for assessing the efficacy of percutaneous coronary intervention (PCI). Yet, the clinical adoption of post-PCI FFR is limited. Murray law-based quantitative flow ratio (μQFR) may represent a promisin...
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2025-01-01
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| author | Daixin Ding, PhD Jinlong Zhang, MD, PhD Peng Wu, PhD Zhiqing Wang, MD, PhD Huiping Shi, MSc Wei Yu, PhD Xinyang Hu, MD, PhD Jeehoon Kang, MD Joo-Yong Hahn, MD Chang-Wook Nam, MD Joon-Hyung Doh, MD Bong-Ki Lee, MD Weon Kim, MD Jinyu Huang, MD Fan Jiang, MD Hao Zhou, MD Peng Chen, MD Lijiang Tang, MD Wenbing Jiang, MD Xiaomin Chen, MD Wenming He, MD Sung Gyun Ahn, MD Myeong-Ho Yoon, MD Ung Kim, MD You-Jeong Ki, MD Eun-Seok Shin, MD Seung-Jea Tahk, MD Jun Pu, MD William Wijns, MD, PhD Jian’an Wang, MD, PhD Bon-Kwon Koo, MD, PhD Shengxian Tu, PhD |
| author_facet | Daixin Ding, PhD Jinlong Zhang, MD, PhD Peng Wu, PhD Zhiqing Wang, MD, PhD Huiping Shi, MSc Wei Yu, PhD Xinyang Hu, MD, PhD Jeehoon Kang, MD Joo-Yong Hahn, MD Chang-Wook Nam, MD Joon-Hyung Doh, MD Bong-Ki Lee, MD Weon Kim, MD Jinyu Huang, MD Fan Jiang, MD Hao Zhou, MD Peng Chen, MD Lijiang Tang, MD Wenbing Jiang, MD Xiaomin Chen, MD Wenming He, MD Sung Gyun Ahn, MD Myeong-Ho Yoon, MD Ung Kim, MD You-Jeong Ki, MD Eun-Seok Shin, MD Seung-Jea Tahk, MD Jun Pu, MD William Wijns, MD, PhD Jian’an Wang, MD, PhD Bon-Kwon Koo, MD, PhD Shengxian Tu, PhD |
| author_sort | Daixin Ding, PhD |
| collection | DOAJ |
| description | Background: Coronary physiology measured by fractional flow reserve (FFR) is superior to angiography for assessing the efficacy of percutaneous coronary intervention (PCI). Yet, the clinical adoption of post-PCI FFR is limited. Murray law-based quantitative flow ratio (μQFR) may represent a promising alternative, as it can quickly compute FFR from a single angiographic view. Objectives: The authors aimed to investigate the potential role of post-PCI μQFR in predicting clinical outcomes. Methods: This was a post hoc blinded analysis of the FLAVOUR trial. Patients with angiographically intermediate lesions randomized 1:1 to receive FFR or intravascular ultrasound-guided PCI were included. Post-PCI μQFR was assessed in successfully stented vessels, blinded to clinical outcomes. Suboptimal physiological outcome post-PCI was defined a priori as post-PCI μQFR <0.90. The primary endpoint was 2-year target vessel failure, including cardiac death, target vessel myocardial infarction, and target vessel revascularization. Secondary endpoints included the diagnostic concordance of pre-PCI μQFR with FFR in the FFR-guidance arm. Results: Post-PCI μQFR was successfully analyzed in 806 vessels from 777 participants (feasibility 97.0% [806 of 831]). Suboptimal physiological outcome post-PCI was identified in 24.7% (199 of 806) of vessels and post-PCI μQFR <0.90 was associated with higher risk of 2-year target vessel failure (6.1% [12 of 199] vs 2.7% [16 of 607]; HR: 2.45 [95% CI: 1.14-5.26]; P = 0.022). Pre-PCI μQFR was obtained in 877 of 919 vessels (feasibility 95.4%), showing 90% accuracy, 82% sensitivity, and 94% specificity for identifying physiologically significant stenosis defined by pre-PCI FFR ≤0.80. Conclusions: In patients with intermediate lesions who underwent PCI with contemporary imaging or physiology guidance, lower post-PCI μQFR values predict subsequent adverse events. (Fractional FLow Reserve And IVUS for Clinical OUtcomes in Patients With InteRmediate Stenosis [FLAVOUR]; NCT02673424) |
| format | Article |
| id | doaj-art-6f0505214c9044bf9099b3b42542ba6e |
| institution | Kabale University |
| issn | 2772-3747 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | JACC: Asia |
| spelling | doaj-art-6f0505214c9044bf9099b3b42542ba6e2025-01-09T06:14:56ZengElsevierJACC: Asia2772-37472025-01-01515970Prognostic Value of Postpercutaneous Coronary Intervention Murray-Law-Based Quantitative Flow RatioDaixin Ding, PhD0Jinlong Zhang, MD, PhD1Peng Wu, PhD2Zhiqing Wang, MD, PhD3Huiping Shi, MSc4Wei Yu, PhD5Xinyang Hu, MD, PhD6Jeehoon Kang, MD7Joo-Yong Hahn, MD8Chang-Wook Nam, MD9Joon-Hyung Doh, MD10Bong-Ki Lee, MD11Weon Kim, MD12Jinyu Huang, MD13Fan Jiang, MD14Hao Zhou, MD15Peng Chen, MD16Lijiang Tang, MD17Wenbing Jiang, MD18Xiaomin Chen, MD19Wenming He, MD20Sung Gyun Ahn, MD21Myeong-Ho Yoon, MD22Ung Kim, MD23You-Jeong Ki, MD24Eun-Seok Shin, MD25Seung-Jea Tahk, MD26Jun Pu, MD27William Wijns, MD, PhD28Jian’an Wang, MD, PhD29Bon-Kwon Koo, MD, PhD30Shengxian Tu, PhD31Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Lambe Institute for Translational Research, Smart Sensors Laboratory and CÚRAM, University of Galway, Galway, IrelandDepartment of Cardiology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, ChinaBiomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaBiomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, ChinaPulse Medical, Shanghai, ChinaBiomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Cardiology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, ChinaDepartment of Cardiology, Seoul National University Hospital, Seoul, Republic of KoreaSamsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaKeimyung University Dongsan Medical Center, Daegu, Republic of KoreaInje University Ilsan Paik Hospital, Seoul, Republic of KoreaKangwon National University Hospital, Gangwon, Republic of KoreaKyung Hee University Hospital, Seoul, Republic of KoreaAffiliated Hangzhou First Peoples Hospital, Hangzhou, ChinaHangzhou Normal University Affiliated Hospital, Hangzhou, ChinaThe 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, ChinaThe 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, ChinaZhejiang Hospital, Hangzhou, ChinaThe Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, ChinaNingbo First Hospital, Ningbo, ChinaThe Affiliated Hospital of Medical School of Ningbo University, Ningbo, ChinaWonju Severance Christian Hospital, Wonju, Republic of KoreaAjou University Hospital, Suwon, Republic of KoreaYeungnam University Medical Center, Daegu, Republic of KoreaUijeongbu Eulji Medical Center, Seongnam, Republic of KoreaDepartment of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of KoreaAjou University Hospital, Suwon, Republic of KoreaDepartment of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaLambe Institute for Translational Research, Smart Sensors Laboratory and CÚRAM, University of Galway, Galway, IrelandDepartment of Cardiology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, ChinaDepartment of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea; Prof Bon-Kwon Koo, Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul 110-744, Korea.Department of Cardiology, Ren Ji Hospital, School of Medicine, and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Address for correspondence: Prof Shengxian Tu, Room 123, Med-X Research Institute, Shanghai Jiao Tong University, No. 1954, Hua Shan Road, Shanghai 200030, China.Background: Coronary physiology measured by fractional flow reserve (FFR) is superior to angiography for assessing the efficacy of percutaneous coronary intervention (PCI). Yet, the clinical adoption of post-PCI FFR is limited. Murray law-based quantitative flow ratio (μQFR) may represent a promising alternative, as it can quickly compute FFR from a single angiographic view. Objectives: The authors aimed to investigate the potential role of post-PCI μQFR in predicting clinical outcomes. Methods: This was a post hoc blinded analysis of the FLAVOUR trial. Patients with angiographically intermediate lesions randomized 1:1 to receive FFR or intravascular ultrasound-guided PCI were included. Post-PCI μQFR was assessed in successfully stented vessels, blinded to clinical outcomes. Suboptimal physiological outcome post-PCI was defined a priori as post-PCI μQFR <0.90. The primary endpoint was 2-year target vessel failure, including cardiac death, target vessel myocardial infarction, and target vessel revascularization. Secondary endpoints included the diagnostic concordance of pre-PCI μQFR with FFR in the FFR-guidance arm. Results: Post-PCI μQFR was successfully analyzed in 806 vessels from 777 participants (feasibility 97.0% [806 of 831]). Suboptimal physiological outcome post-PCI was identified in 24.7% (199 of 806) of vessels and post-PCI μQFR <0.90 was associated with higher risk of 2-year target vessel failure (6.1% [12 of 199] vs 2.7% [16 of 607]; HR: 2.45 [95% CI: 1.14-5.26]; P = 0.022). Pre-PCI μQFR was obtained in 877 of 919 vessels (feasibility 95.4%), showing 90% accuracy, 82% sensitivity, and 94% specificity for identifying physiologically significant stenosis defined by pre-PCI FFR ≤0.80. Conclusions: In patients with intermediate lesions who underwent PCI with contemporary imaging or physiology guidance, lower post-PCI μQFR values predict subsequent adverse events. (Fractional FLow Reserve And IVUS for Clinical OUtcomes in Patients With InteRmediate Stenosis [FLAVOUR]; NCT02673424)http://www.sciencedirect.com/science/article/pii/S277237472400454Xangiography-based physiologyclinical outcomefractional flow reserveintravascular ultrasoundpercutaneous coronary interventionquantitative flow ratio |
| spellingShingle | Daixin Ding, PhD Jinlong Zhang, MD, PhD Peng Wu, PhD Zhiqing Wang, MD, PhD Huiping Shi, MSc Wei Yu, PhD Xinyang Hu, MD, PhD Jeehoon Kang, MD Joo-Yong Hahn, MD Chang-Wook Nam, MD Joon-Hyung Doh, MD Bong-Ki Lee, MD Weon Kim, MD Jinyu Huang, MD Fan Jiang, MD Hao Zhou, MD Peng Chen, MD Lijiang Tang, MD Wenbing Jiang, MD Xiaomin Chen, MD Wenming He, MD Sung Gyun Ahn, MD Myeong-Ho Yoon, MD Ung Kim, MD You-Jeong Ki, MD Eun-Seok Shin, MD Seung-Jea Tahk, MD Jun Pu, MD William Wijns, MD, PhD Jian’an Wang, MD, PhD Bon-Kwon Koo, MD, PhD Shengxian Tu, PhD Prognostic Value of Postpercutaneous Coronary Intervention Murray-Law-Based Quantitative Flow Ratio JACC: Asia angiography-based physiology clinical outcome fractional flow reserve intravascular ultrasound percutaneous coronary intervention quantitative flow ratio |
| title | Prognostic Value of Postpercutaneous Coronary Intervention Murray-Law-Based Quantitative Flow Ratio |
| title_full | Prognostic Value of Postpercutaneous Coronary Intervention Murray-Law-Based Quantitative Flow Ratio |
| title_fullStr | Prognostic Value of Postpercutaneous Coronary Intervention Murray-Law-Based Quantitative Flow Ratio |
| title_full_unstemmed | Prognostic Value of Postpercutaneous Coronary Intervention Murray-Law-Based Quantitative Flow Ratio |
| title_short | Prognostic Value of Postpercutaneous Coronary Intervention Murray-Law-Based Quantitative Flow Ratio |
| title_sort | prognostic value of postpercutaneous coronary intervention murray law based quantitative flow ratio |
| topic | angiography-based physiology clinical outcome fractional flow reserve intravascular ultrasound percutaneous coronary intervention quantitative flow ratio |
| url | http://www.sciencedirect.com/science/article/pii/S277237472400454X |
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