Prognostic role of discordance between quantitative flow ratio and visual estimation in revascularization guidance
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology..
Aims: Revascularization guided by functional severity has presented improved outcomes compared with visual angiographic guidance. Quantitative flow ratio (QFR) is a reliable angiography-based method for functional assessment. We sought to investigate the prognostic value of discordance between QFR and visual estimation in coronary revascularization guidance.
Methods and results: We performed offline QFR analysis on all-comers undergoing coronary angiography. Vessels with calculated QFR were divided into four groups based on the decision to perform or defer percutaneous coronary intervention (PCI) and on the QFR result, i.e.: Group A (PCI-, QFR > 0.8); Group B (PCI+, QFR ≤ 0.8); Group C (PCI+, QFR > 0.8); Group D (PCI-, QFR ≤ 0.8). Patients with at least one vessel falling within the disagreement groups formed the discordance group, whereas the remaining patients formed the concordance group. The primary endpoint was the composite endpoint of cardiovascular death, myocardial infarction, and ischaemia-driven revascularization. Overall, 546 patients were included in the study. Discordance between QFR and visual estimation was found in 26.2% of patients. After a median follow-up period of 2.5 years, the discordance group had a significantly higher rate of the composite outcome (hazard ratio: 3.34, 95% confidence interval 1.99-5.60, P < 0.001). Both disagreement vessel Groups C and D were associated with increased cardiovascular risk compared with agreement Groups A and B.
Conclusion: Discordance between QFR and visual estimation in revascularization guidance was associated with a worse long-term prognosis. Our results highlight the importance of proper patient selection for intervention and the need to avoid improper stent implantations when not dictated by a comprehensive functional assessment.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:4 |
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| Enthalten in: |
European heart journal open - 4(2024), 1 vom: 26. Jan., Seite oead125 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Terentes-Printzios, Dimitrios [VerfasserIn] |
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| Links: |
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| Themen: |
Coronary angiography |
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| Anmerkungen: |
Date Revised 05.01.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1093/ehjopen/oead125 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM366649655 |
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| 245 | 1 | 0 | |a Prognostic role of discordance between quantitative flow ratio and visual estimation in revascularization guidance |
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| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. | ||
| 520 | |a Aims: Revascularization guided by functional severity has presented improved outcomes compared with visual angiographic guidance. Quantitative flow ratio (QFR) is a reliable angiography-based method for functional assessment. We sought to investigate the prognostic value of discordance between QFR and visual estimation in coronary revascularization guidance | ||
| 520 | |a Methods and results: We performed offline QFR analysis on all-comers undergoing coronary angiography. Vessels with calculated QFR were divided into four groups based on the decision to perform or defer percutaneous coronary intervention (PCI) and on the QFR result, i.e.: Group A (PCI-, QFR > 0.8); Group B (PCI+, QFR ≤ 0.8); Group C (PCI+, QFR > 0.8); Group D (PCI-, QFR ≤ 0.8). Patients with at least one vessel falling within the disagreement groups formed the discordance group, whereas the remaining patients formed the concordance group. The primary endpoint was the composite endpoint of cardiovascular death, myocardial infarction, and ischaemia-driven revascularization. Overall, 546 patients were included in the study. Discordance between QFR and visual estimation was found in 26.2% of patients. After a median follow-up period of 2.5 years, the discordance group had a significantly higher rate of the composite outcome (hazard ratio: 3.34, 95% confidence interval 1.99-5.60, P < 0.001). Both disagreement vessel Groups C and D were associated with increased cardiovascular risk compared with agreement Groups A and B | ||
| 520 | |a Conclusion: Discordance between QFR and visual estimation in revascularization guidance was associated with a worse long-term prognosis. Our results highlight the importance of proper patient selection for intervention and the need to avoid improper stent implantations when not dictated by a comprehensive functional assessment | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Coronary angiography | |
| 650 | 4 | |a Fractional flow reserve | |
| 650 | 4 | |a Percutaneous coronary intervention | |
| 650 | 4 | |a Prognosis | |
| 650 | 4 | |a Quantitative flow ratio | |
| 700 | 1 | |a Oikonomou, Dimitrios |e verfasserin |4 aut | |
| 700 | 1 | |a Gkini, Konstantia-Paraskevi |e verfasserin |4 aut | |
| 700 | 1 | |a Gardikioti, Vasiliki |e verfasserin |4 aut | |
| 700 | 1 | |a Aznaouridis, Konstantinos |e verfasserin |4 aut | |
| 700 | 1 | |a Dima, Ioanna |e verfasserin |4 aut | |
| 700 | 1 | |a Tsioufis, Konstantinos |e verfasserin |4 aut | |
| 700 | 1 | |a Vlachopoulos, Charalambos |e verfasserin |4 aut | |
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