Prognostic role of discordance between plain coronary angiography and quantitative flow ratio in revascularization guidance

Abstract

Abstract Background/Introduction Percutaneous coronary intervention (PCI) guided by functional coronary stenosis severity has been associated with less clinical adverse events compared with plain coronary angiography. Quantitative flow ratio (QFR) has proven to be a reliable tool for functional assessment of coronary lesions. Purpose To investigate the prognostic role and the extend of disagreement between plain coronary angiography and QFR in guiding the decision to treat a coronary lesion. Methods We retrospectively performed an offline QFR analysis in consecutive patients who underwent coronary angiography in a single center. Patients with referral for coronary artery bypass graft surgery after coronary angiography were excluded. We aimed to measure QFR in all vessels of each patient. Patients were divided in two groups according to the concordance or discordance of the two methods. Patients with at least one vessel with QFR value ≥0.80 treated with PCI and/or at least one vessel with QFR value <0.80 not treated with PCI were included in the discordance group. The remaining patients formed the concordance group. Primary endpoint was the composite outcome of cardiovascular death, myocardial infraction and ischemia-driven revascularization. Results Overall, we included 549 patients in the study. Concordance between plain coronary angiography and QFR was present in 404 (73.6%) patients, while discordance between the two methods was found in 145 patients (26.4%). Baseline patient characteristics are displayed in Figure 1. Patients in the discordance group were older, with more extended coronary artery disease and higher SYNTAX score. After a median follow-up period of 30.5 (26.4–33.7) months, multivariate regression analysis showed significant higher rate of the composite outcome in the discordance group (OR: 2.975 95% CI 1.782–4.967, p<0.001) (Figure 2). Conclusion In our study, discordance between plain coronary angiography and QFR in revascularization guidance was present in approximately one fourth of patients and was found to be a strong independent predictor of higher cardiovascular adverse events. Funding Acknowledgement Type of funding sources: None.