Validation of angiography-based FFR in non-culprit vessels of patients presenting with STEMI.

IF 3.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Research in Cardiology Pub Date : 2025-09-08 DOI:10.1007/s00392-025-02729-x

Jari A van der Eijk, Frederik T W Groenland, Alessandra Scoccia, Annemieke C Ziedses des Plantes, Jager Huang, Rutger-Jan Nuis, Jeroen M Wilschut, Wijnand K den Dekker, Roberto Diletti, Isabella Kardys, Mariusz Tomaniak, Nicolas M Van Mieghem, Joost Daemen

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引用次数: 0

Abstract

Background: Fractional flow reserve (FFR) for non-culprit lesions (NCLs) in patients with ST-elevation myocardial infarction (STEMI) can be influenced by temporary changes in microvascular resistance. Angiography-derived vessel fractional flow reserve (vFFR) has been tested as a less-invasive alternative.

Aims: The FAST STEMI II study aimed to assess the diagnostic performance of acute-setting vFFR vs. FFR for intermediate NCLs in STEMI patients.

Methods: FAST STEMI II is a prospective two-center cohort study including STEMI patients with ≥ 1 intermediate NCL (50-90% diameter stenosis). Patients with cardiogenic shock, prior revascularization of the non-culprit vessel, or aorta-ostial lesions were excluded. Following primary percutaneous coronary intervention (PCI), vFFR, FFR, resting full-cycle ratio (RFR), coronary flow reserve (CFR), and index of microcirculatory resistance (IMR) measurements of the NCL were performed.

Results: A total of 111 patients were included. Median [25th-75th percentile] vFFR and FFR were 0.83 [0.74-0.88] and 0.83 [0.80-0.90], respectively. vFFR had a moderate to good discriminative ability to predict FFR ≤ 0.80 (AUC: 0.78; 95% CI: 0.68-0.89; p < 0.001) with a moderate correlation (r = 0.54; p < 0.001). Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of vFFR to predict FFR ≤ 0.80 were 72%, 76%, 70%, 53%, and 87%, respectively. Microvascular dysfunction (CFR < 2.0 and IMR ≥ 25) was observed in 33 (31%) patients. In patients with microvascular dysfunction, median vFFR and FFR values were 0.76 [0.71-0.86] and 0.85 [0.77-0.90], respectively (p = 0.002).

Conclusions: We found moderate correlation between vFFR and FFR in NCLs of patients undergoing primary PCI. Discordance between vFFR and FFR was associated with the presence of microvascular dysfunction. The study was conducted in accordance with Good Clinical Practice and the Declaration of Helsinki and was registered at 22-jun-2023 on clinicaltrials.gov under the identifier NCT05698719.

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STEMI患者非元凶血管造影基础FFR的验证

背景：st段抬高型心肌梗死（STEMI）患者非元凶病变（NCLs）的分数血流储备（FFR）可受微血管阻力的暂时变化影响。血管造影衍生的血管分数血流储备（vFFR）已被测试为一种侵入性较小的替代方法。目的：FAST STEMI II研究旨在评估急性背景vFFR与FFR对STEMI中期nclc患者的诊断性能。方法：FAST STEMI II是一项前瞻性双中心队列研究，纳入STEMI患者≥1中度NCL（直径狭窄50-90%）。排除心源性休克、非主因血管重建术或主动脉-口病变的患者。经皮冠状动脉介入治疗（PCI）后，测量NCL的vFFR、FFR、静息全周期比（RFR）、冠状动脉血流储备（CFR）和微循环阻力指数（IMR）。结果：共纳入111例患者。中位[25 -75百分位]vFFR和FFR分别为0.83[0.74-0.88]和0.83[0.80-0.90]。vFFR具有中等至良好的判别能力，预测FFR≤0.80 （AUC: 0.78; 95% CI: 0.68-0.89; p）结论：我们发现在接受初级PCI的nclc患者中，vFFR与FFR之间存在中度相关性。vFFR和FFR之间的不一致与微血管功能障碍的存在有关。该研究按照良好临床实践和赫尔辛基宣言进行，并于2023年6月22日在clinicaltrials.gov上注册，标识符为NCT05698719。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Research in Cardiology 医学-心血管系统

CiteScore

11.40

自引率

4.00%

发文量

140

审稿时长

4-8 weeks

期刊介绍： Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery. As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.