Quantitative flow ratio-based revascularization on clinical outcomes in multivessel disease STEMI patients with chronic kidney disease.

Abstract

Background: Patients with multivessel disease and ST-elevation myocardial infarction (MVD-STEMI) have a poor prognosis but benefit from quantitative flow ratio (QFR)-based revascularization. The influence of chronic kidney disease (CKD) on this benefit is unclear. This study aimed to evaluate differences in clinical outcomes of QFR-based revascularization in MVD-STEMI patients with or without CKD.

Methods: A total of 495 patients with MVD-STEMI who underwent primary percutaneous coronary intervention (PCI) were included in the study. Patients were divided into nonCKD and CKD cohort, and were further stratified into functional complete revascularization (FCR) and functional incomplete revascularization (FIR) layer based on QFR assessments. The primary outcomes were 3-year major adverse cardiovascular events (MACEs).

Results: The incidence of MACEs was lower in FCR than FIR layers in both nonCKD and CKD cohorts (p = 0.014, p = 0.008), but the percentage decrease in MACEs from FIR to FCR in CKD was greater than that in nonCKD cohort (53.1 % vs 49.7 %). The baseline QFR measurements were significantly lower in FIR patients with CKD than with nonCKD (p < 0.001). The residual SYNTAX score derived from QFR (RSS_QFR) was significantly associated with the increased risk of MACEs in both cohorts (p < 0.001). Incorporating RSS_QFR into prognostic models improved MACE prediction, especially in CKD cohort than in nonCKD cohort (difference in area under the curve = -0.143 vs difference in area under the curve = -0.133).

Conclusions: In MVD-STEMI patients, the CKD population showed greater absolute risk reduction, which could be attributed to either their higher baseline risk or possible enhanced QFR efficacy. The ability of the QFR-based scoring system to predict prognosis was stronger in the CKD population than in the nonCKD population.