Quantitative flow ratio-guided staged percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

Abstract

BackgroundThe need for primary percutaneous coronary intervention (PCI) and staged PCI strategy for ST-segment elevation myocardial infarction (STEMI) with multivessel coronary disease is well documented. This study aimed to evaluate the efficiency, safety, and cost benefit of quantitative flow ratio (QFR)-guided staged PCI in patients with STEMI. MethodsWe conducted a retrospective study involving 2256 patients meeting STEMI criteria having at least one lesion (≥50 %) in non-infarct-related (NIR) arteries. These patients had undergone primary PCI for infarct-related (IR) arteries and staged PCI for NIR arteries. Patients were categorized into two groups based on the strategy guided either by QFR or quantitative coronary angiography (QCA) as determined by the clinicians during primary PCI in real-world. For patients guided by QFR, a threshold of ≤0.80 serves as the cut-off value for determining the need for PCI. We recorded the demographics, clinical data, and QFR values of none-infarct-related arteries. The efficiency, safety, and cost benefit of the QFR-guided staged PCI were evaluated. ResultsThe QCA-guided group had a higher rate of Killip II. In the QFR-guided group, there was a higher proportion of left anterior descending coronary artery lesions in infarct-related arteries. The mean QFR value of non-infarct-related (NIR) arteries remained consistent at 0.83 across both groups, irrespective of whether the measurement was taken during the primary PCI or the staged PCI phase. Among patients with QFR ≤0.8, the QFR values during staged PCI were significantly higher than that during primary PCI, with a significantly greater increase compared to patients with QFR >0.8. The proportion of staged PCI, number of stents per patient, and cost of staged PCI per patient were significantly lower in the QFR-guided group compared to the QCA-guided group. In the long-term follow-up period, there were no statistically significant differences between the two groups in terms of major adverse cardiac events and clinic visits, except for target vessel revascularization. ConclusionsQFR resulted in a reduction in the proportion of STEMI patients with multivessel coronary disease undergoing invasive coronary angiography and staged PCI. Furthermore, it decreased the incidence of target vessel revascularization (TVR) and medical costs, without increasing major adverse cardiovascular events. Our future work will focus on large multi-center perspective studies for the feasibility of QFR guided staged PCI in patients with STEMI.