Prognostic Value of Postpercutaneous Coronary Intervention Murray-Law-Based Quantitative Flow Ratio
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
Affiliations
Daixin Ding, PhD
Department 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, Ireland
Jinlong Zhang, MD, PhD
Department of Cardiology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
Peng Wu, PhD
Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
Zhiqing Wang, MD, PhD
Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, China
Huiping Shi, MSc
Pulse Medical, Shanghai, China
Wei Yu, PhD
Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
Xinyang Hu, MD, PhD
Department of Cardiology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
Jeehoon Kang, MD
Department of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
Joo-Yong Hahn, MD
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Chang-Wook Nam, MD
Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
Joon-Hyung Doh, MD
Inje University Ilsan Paik Hospital, Seoul, Republic of Korea
Bong-Ki Lee, MD
Kangwon National University Hospital, Gangwon, Republic of Korea
Weon Kim, MD
Kyung Hee University Hospital, Seoul, Republic of Korea
Jinyu Huang, MD
Affiliated Hangzhou First Peoples Hospital, Hangzhou, China
Fan Jiang, MD
Hangzhou Normal University Affiliated Hospital, Hangzhou, China
Hao Zhou, MD
The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
Peng Chen, MD
The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
Lijiang Tang, MD
Zhejiang Hospital, Hangzhou, China
Wenbing Jiang, MD
The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, China
Xiaomin Chen, MD
Ningbo First Hospital, Ningbo, China
Wenming He, MD
The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
Sung Gyun Ahn, MD
Wonju Severance Christian Hospital, Wonju, Republic of Korea
Myeong-Ho Yoon, MD
Ajou University Hospital, Suwon, Republic of Korea
Ung Kim, MD
Yeungnam University Medical Center, Daegu, Republic of Korea
You-Jeong Ki, MD
Uijeongbu Eulji Medical Center, Seongnam, Republic of Korea
Eun-Seok Shin, MD
Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
Seung-Jea Tahk, MD
Ajou University Hospital, Suwon, Republic of Korea
Jun Pu, MD
Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
William Wijns, MD, PhD
Lambe Institute for Translational Research, Smart Sensors Laboratory and CÚRAM, University of Galway, Galway, Ireland
Jian’an Wang, MD, PhD
Department of Cardiology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
Bon-Kwon Koo, MD, PhD
Department 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.
Shengxian Tu, PhD
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)
