Highlights
- •Contrast quantitative flow ratio (cQFR) showed excellent diagnostic performance with fractional flow reserve (FFR).
- •Vessels with low cQFR was associated with significantly higher risks of vessel oriented composite outcome (VOCO) than those with high cQFR.
- •On this basis, cQFR might be a reasonable option for functional assessment of coronary stenosis regardless of clinical presentation or characteristics.
Abstract
Background
We sought to evaluate the diagnostic performance of contrast quantitative flow ratio
(cQFR) in all-comer patients with coronary artery disease, and to compare the vessel-oriented
composite outcomes (VOCO) according to cQFR values.
Method
599 vessels with 452 patients who underwent clinically indicated fractional flow reserve
(FFR) and cQFR measurement were evaluated. The cQFR, derived from 3-dimensional quantitative
coronary angiography combined with TIMI frame-counts was compared with FFR as a reference
standard. The risk of VOCO at 2 years, a composite of cardiac death, target-vessel
myocardial infarction, and ischemia-driven target lesion revascularization, was compared
according to cQFR and FFR value.
Results
cQFR strongly correlated with FFR (r=0.860, p<0.001) and showed diagnostic accuracy
of 91.2% to predict FFR≤0.80. cQFR showed significantly higher c-index to predict
FFR≤0.80 (0.953, 95%CI 0.937-0.969) than %DS, percent area stenosis, resting distal
coronary pressure/aortic pressure, and fixed QFR (p<0.001). Diagnostic accuracy of
cQFR was not different according to various subgroups including non-culprit vessel
of acute coronary syndrome and diabetes mellitus. Vessels with low cQFR (≤0.80) showed
a significantly higher risk of VOCO at 2-year compared to those with high cQFR (>0.80)
(HR 4.650, 95%CI 1.254-17.240, p=0.022). Discriminatory ability of cQFR for VOCO was
similar with that of FFR (0.672 vs. 0.643, p=0.147).
Conclusion
cQFR showed excellent correlation and diagnostic accuracy with FFR in diverse clinical
presentations or patient characteristics. Low cQFR was significantly associated with
a higher risk of VOCO at 2 years compared with high cQFR and cQFR showed similar discriminatory
ability for VOCO with FFR.
Keywords
Abbreviations:
ACS (acute coronary syndrome), FFR (fractional flow reserve), iFR (instantaneous wave-free ratio), IHD (ischemic heart disease), MI (myocardial infarction), PCI (percutaneous coronary intervention), QCA (quantitative coronary angiography), QFR (quantitative flow ratio), TLR (target lesion revascularization), VOCO (vessel-oriented composite outcome)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 07, 2020
Accepted:
September 1,
2020
Received in revised form:
June 16,
2020
Received:
May 7,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
