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Abstract
The quantitative flow ratio (QFR) is a novel angiography-based computational method assessing functional ischemia caused by coronary stenosis. This study aimed to evaluate the diagnostic performance of quantitative flow ratio (QFR) in patients with angina and acute myocardial infarction (AMI) and to identify the conditions with low diagnostic performance. We assessed the QFR for 1077 vessels under fractional flow ratio (FFR) evaluation in 915 patients with angina and AMI. The diagnostic accuracies of the QFR for identifying an FFR ≤ 0.8 were 95.98% (95% confidence interval [CI] 94.52 to 97.14%) for the angina group and 92.42% (95% CI 86.51 to 96.31%) for the AMI group. The diagnostic accuracy of the QFR in the borderline FFR zones (> 0.75, ≤ 0.85) (91.23% [95% CI 88.25 to 93.66%]) was significantly lower than that in others (difference: 4.32; p = 0.001). The condition accompanying both AMI and the borderline FFR zone showed the lowest QFR diagnostic accuracy in our data (83.93% [95% CI 71.67 to 92.38]). The diagnostic accuracy was reduced for tandem lesions (p = 0.04, not correcting for multiple testing). Our study found that the QFR method yielded a high overall diagnostic performance in real-world patients. However, low diagnostic accuracy has been observed in borderline FFR zones with AMI, and the hybrid FFR approach needs to be considered.
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1 The Catholic University of Korea, Department of Cardiology, Incheon St. Mary’s Hospital, Incheon, Republic of Korea (GRID:grid.411947.e) (ISNI:0000 0004 0470 4224)
2 The Catholic University of Korea, Department of Cardiology, Seoul St. Mary’s Hospital, Seoul, Republic of Korea (GRID:grid.411947.e) (ISNI:0000 0004 0470 4224)
3 The Catholic University of Korea, Cardiovascular Research Institute, Seoul St. Mary’s Hospital, Seoul, Republic of Korea (GRID:grid.411947.e) (ISNI:0000 0004 0470 4224)
4 The Catholic University of Korea, Department of Cardiology, Uijeongbu St. Mary’s Hospital, Uijeongbu, Republic of Korea (GRID:grid.411947.e) (ISNI:0000 0004 0470 4224)
5 University of Ulsan, School of Mechanical Engineering, Ulsan, Republic of Korea (GRID:grid.267370.7) (ISNI:0000 0004 0533 4667)
6 Sungkyunkwan University School of Medicine, Department of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (GRID:grid.264381.a) (ISNI:0000 0001 2181 989X)
7 The Catholic University of Korea, Department of Radiology, Incheon St Mary’s Hospital, Incheon, Republic of Korea (GRID:grid.411947.e) (ISNI:0000 0004 0470 4224)
8 Ajou University Medical Center, Department of Cardiology, Suwon, Republic of Korea (GRID:grid.411261.1) (ISNI:0000 0004 0648 1036)