Prognostic impact of quantitative flow ratio (QFR)-consistent complete revascularization in patients with myocardial infarction and multivessel coronary artery disease.

Autor:	Erbay A; Department of Cardiology, University Heart Centre Frankfurt, University Hospital Frankfurt, Frankfurt/Main, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Rhine-Main, Frankfurt/Main, Germany. Electronic address: erbay@med.uni-frankfurt.de., Penzel L; Department of Cardiology, German Heart Centre Charité (DHZC), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany., Abdelwahed YS; Department of Cardiology, German Heart Centre Charité (DHZC), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany., Heuberger A; Department of Cardiology, German Heart Centre Charité (DHZC), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany., Schatz AS; Department of Cardiology, German Heart Centre Charité (DHZC), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany., Seppelt C; Department of Cardiology, University Heart Centre Frankfurt, University Hospital Frankfurt, Frankfurt/Main, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Rhine-Main, Frankfurt/Main, Germany., Schlender LS; Department of Cardiology, University Heart Centre Frankfurt, University Hospital Frankfurt, Frankfurt/Main, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Rhine-Main, Frankfurt/Main, Germany., Steiner J; Department of Cardiology, German Heart Centre Charité (DHZC), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany., Haghikia A; Department of Cardiology, German Heart Centre Charité (DHZC), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany., Steven S; Department of Cardiology, University Heart Centre Frankfurt, University Hospital Frankfurt, Frankfurt/Main, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Rhine-Main, Frankfurt/Main, Germany., Landmesser U; Department of Cardiology, German Heart Centre Charité (DHZC), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany., Stähli BE; Department of Cardiology, German Heart Centre Charité (DHZC), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany; Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland., Leistner DM; Department of Cardiology, University Heart Centre Frankfurt, University Hospital Frankfurt, Frankfurt/Main, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Rhine-Main, Frankfurt/Main, Germany.
Jazyk:	angličtina
Zdroj:	American heart journal [Am Heart J] 2024 Oct; Vol. 276, pp. 22-30. Date of Electronic Publication: 2024 Jul 20.
DOI:	10.1016/j.ahj.2024.07.011
Abstrakt:	Background: Complete revascularization is associated with improved outcomes in patients with myocardial infarction and multivessel coronary artery disease. Quantitative flow ratio (QFR) represents an emerging angiography-based tool for functional lesion assessment. The present study investigated the prognostic impact of QFR-consistent complete revascularization in patients with myocardial infarction and multivessel disease. Methods: A total of 792 patients with myocardial infarction and multivessel disease were enrolled in the analysis. Post-hoc QFR analyses of 1,320 nonculprit vessels were performed by investigators blinded to clinical outcomes. The primary endpoint was a composite of all-cause death, nonculprit vessel related nonfatal myocardial infarction, and ischemia-driven revascularization at 2 years after index myocardial infarction. Patients were stratified into a QFR-consistent PCI group (n = 646) and a QFR-inconsistent PCI group (n = 146), based on whether the intervention was congruent with the QFR-determined functional significance of the nonculprit lesions. Results: The primary endpoint occurred in a total of 22 patients (3.4%) in the QFR-consistent PCI group and in 27 patients (18.5%) in the QFR-inconsistent group (HR 0.17, 95% CI 0.10-0.30, P < .001).The difference in the primary endpoint was driven by reduced rates of nonfatal myocardial infarction (2.0% vs. 15.1%; HR 0.13, 95% CI 0.06-0.25; P < .001) and ischemia-driven revascularization (1.2% vs. 5.5%; HR 0.21, 95% CI 0.08-0.57; P = .001) in the QFR-consistent PCI group. Conclusions: Among patients with myocardial infarction and multivessel disease, a QFR-consistent complete revascularization was associated with a reduced risk of all-cause mortality, nonfatal myocardial infarction, and ischemia-driven revascularization. These findings underline the value of angiography-based functional lesion assessment for personalized revascularization strategies. Competing Interests: Conflict of interest None. (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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