Correlation and Relative Prognostic Value of Fractional Flow Reserve and Pd/Pa of Nonculprit Lesions in ST-Segment-Elevation Myocardial Infarction.

Autor:	Piróth Z; Hungarian Institute of Cardiology, Budapest, Hungary (Z.P., G.F., P.A., G.F.)., Fülöp G; Hungarian Institute of Cardiology, Budapest, Hungary (Z.P., G.F., P.A., G.F.)., Boxma-de Klerk BM; Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (B.M.B.-d.K., P.C.S.).; Department of Statistics and Education, Franciscus Academy, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands (B.M.B.-d.K.)., Abdelghani M; Amsterdam UMC, University of Amsterdam, the Netherlands (M.A.).; Department of Cardiology, Al-Azhar University, Cairo, Egypt (M.A.)., Omerovic E; Department of Cardiology, Gothenburg University Hospital, Sweden (E.O.)., Andréka P; Hungarian Institute of Cardiology, Budapest, Hungary (Z.P., G.F., P.A., G.F.)., Fontos G; Hungarian Institute of Cardiology, Budapest, Hungary (Z.P., G.F., P.A., G.F.)., Neumann FJ; Department of Cardiology, University Heart Center Freiburg - Bad Krozingen, Germany (F.-J.N.)., Richardt G; Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (G.R.)., Smits PC; Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (B.M.B.-d.K., P.C.S.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2022 Feb; Vol. 15 (2), pp. e010796. Date of Electronic Publication: 2022 Jan 20.
DOI:	10.1161/CIRCINTERVENTIONS.121.010796
Abstrakt:	Background: The applicability of resting indices to guide noninfarct-related artery revascularization in ST-elevation myocardial infarction is unknown. Methods: We analyzed the correlation and prognostic value of fractional flow reserve (FFR) and resting distal coronary to aortic pressure ratio (Pd/Pa) in all patients of the Compare-Acute trial in whom, after successful primary percutaneous coronary intervention, the noninfarct-related artery was interrogated by both and treated medically. The treating cardiologist was blinded to these values. The primary end point was the composite of target vessel (interrogated noninfarct-related artery) related nonfatal target vessel myocardial infarction and target vessel repeat revascularization at 36 months. Results: Five hundred seventeen patients (665 vessels) were included. On receiver-operating characteristic analysis, the optimal Pd/Pa cut off for FFR≤0.80 was 0.905 ( C statistic: 0.894). The diagnostic accuracy of Pd/Pa was 80.15% (95% CI, 76.91%-83.12%) with respect to FFR. During the 36-month follow-up, 130 target vessel revascularization and 14 target vessel myocardial infarction occurred. FFR and Pd/Pa had a diagnostic accuracy to predict these events of 62.86% (95% CI, 59.06%-66.54%) and 56.84% (95% CI, 52.98%-60.64%), respectively ( P =0.20). When they were discrepant, FFR was significantly better than Pd/Pa in identifying which vessels could be safely deferred ( P =0.048). Conclusions: Immediately after successful primary percutaneous coronary intervention, resting Pd/Pa has a diagnostic accuracy of 80% with respect to FFR measured in the noninfarct-related artery. FFR is not significantly superior in predicting target vessel myocardial infarction and target vessel revascularization during 36 months of follow-up but, in case FFR and Pd/Pa are discrepant, FFR is superior in identifying which nonculprit vessels can be safely deferred. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01399736.
Databáze:	MEDLINE
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