Feasibility of Quantitative Flow Ratio Virtual Stenting for Guidance of Serial Coronary Lesions Intervention.
J Am Heart Assoc
; 11(19): e025663, 2022 10 04.
Article
en En
| MEDLINE
| ID: mdl-36129050
ABSTRACT
Background Coronary physiology measurement in serial coronary lesions with multiple stenoses is challenging. Therefore, we evaluated the feasibility of Murray fractal law-based quantitative flow ratio (µQFR) virtual stenting for guidance of serial coronary lesions intervention. Methods and Results Patients who underwent elective coronary angiography and had 2 serial de novo coronary lesions of 30% to 90% diameter stenosis by visual estimation were prospectively enrolled. µQFR and fractional flow reserve (FFR) were assessed after coronary angiography. In vessels with an FFR ≤0.80, the lesion with the larger pressure gradient was considered to be the primary lesion and treated firstly, followed by FFR measurement. The second lesion was stented when FFR ≤0.80. All µQFR and predicted µQFR after stenting were calculated from diagnostic coronary angiography before interventions, with the analysts masked to the FFR data. A total of 54 patients with 61 target vessels were interrogated. Percutaneous coronary intervention was performed in 44 vessels with FFR ≤0.80. After stenting the primary lesions, 14 nonprimary lesions had FFR ≤0.80 and a second drug-eluting stent was implanted. There was excellent correlation (r=0.97, P<0.001) and good agreement (mean difference 0.00±0.03) between baseline µQFR and FFR in identifying flow-limiting lesions. Per-vessel diagnostic accuracy of µQFR on de novo lesions was 96.7% (95% CI, 88.7%-99.6%). µQFR and FFR are highly consistent (93.2%) in identifying the primary lesion requiring revascularization. After stenting the primary lesions, per-vessel diagnostic accuracy of predicted µQFR for identifying the significance of the nonprimary lesion was 90.9%. Predicted residual µQFR with virtual stenting was higher than final FFR (mean difference 0.05±0.06). Conclusions In vessels with serial coronary lesions, virtual stenting by µQFR can identify the primary flow-limiting lesion for revascularization.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Enfermedad de la Arteria Coronaria
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Estenosis Coronaria
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Reserva del Flujo Fraccional Miocárdico
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Stents Liberadores de Fármacos
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Intervención Coronaria Percutánea
Tipo de estudio:
Guideline
Límite:
Humans
Idioma:
En
Revista:
J Am Heart Assoc
Año:
2022
Tipo del documento:
Article