Emilio Alfonso Rodríguez, Josep Gómez-Lara, Ramón López-Palop, Enrique Gutiérrez, Luis Renier Goncalves Ramírez, José Valencia, Alfonso Jurado-Román, Juan Gabriel Córdoba Soriano, Antonio Gómez-Menchero, Estefanía Fernández-Peregrina, Carlos Cortés, Paula Tejedor, Raúl Millan, Guillermo Sánchez-Elvira, Tamara García-Camarero, José Antonio Linares Vicente, Eva Rúmiz, Rosa María Cardenal Piris, Irene Elizondo Rua, Jean Paul Vilchez, Salvatore Brugaletta, Lara Fuentes, Ana Marcano, Pilar Carrillo, Álvaro Gabaldón, Armando Pérez de Prado, Joan Antoni Gómez-Hospital
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Our aim was to evaluate the diagnostic accuracy of QFR in intermediate nonculprit lesions during the index ST-segment elevation myocardial infarction (STEMI) procedure compared with positive pressure wire-based fractional flow reserve (FFR ≤0.80) in a staged procedure.</p><p><strong>Methods: </strong>This was a substudy of the multicenter, controlled, and randomized VULNERABLE trial, including 428 intermediate nonculprit lesions from 388 consecutive STEMI patients undergoing FFR assessment in a staged procedure between 1 and 60 days. Off-line QFR analyses were performed during both the index and staged procedures. The primary objective was to assess the diagnostic accuracy of index QFR compared with staged positive FFR.</p><p><strong>Results: </strong>Angiographic vessel diameter (2.80±0.59 vs 2.91±0.57mm; P<.01), stenosis severity (51.33±8.04% vs 50.54±7.63%; P=.053), and QFR values (0.85±0.09 vs 0.86±0.09; P=.120) showed minimal changes between the index and staged procedures. Moderate concordance was observed between index QFR and staged FFR (kappa index=0.629; intraclass correlation coefficient=0.641). The diagnostic accuracy of index QFR for predicting positive FFR was good (area under the curve=0.825). An index QFR cutoff ≤0.80 showed moderate sensitivity (72%) and excellent specificity (91%). An index QFR ≤0.87 achieved a sensitivity of 86% for detecting lesions with positive FFR, with 55% of lesions presenting QFR ≤0.87 at the index procedure.</p><p><strong>Conclusions: </strong>Index QFR demonstrated good diagnostic accuracy for identifying lesions with positive FFR in a staged procedure. However, an index QFR cutoff value of ≤0.80 showed moderate sensitivity and may underdiagnose approximately 3 out of 10 lesions with positive FFR. An index QFR ≤0.87 provided higher sensitivity and may help avoid invasive (staged) procedures in many patients.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":4.9000,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Diagnostic accuracy of quantitative flow ratio for nonculprit intermediate lesions in patients with ST-segment elevation myocardial infarction.\",\"authors\":\"Emilio Alfonso Rodríguez, Josep Gómez-Lara, Ramón López-Palop, Enrique Gutiérrez, Luis Renier Goncalves Ramírez, José Valencia, Alfonso Jurado-Román, Juan Gabriel Córdoba Soriano, Antonio Gómez-Menchero, Estefanía Fernández-Peregrina, Carlos Cortés, Paula Tejedor, Raúl Millan, Guillermo Sánchez-Elvira, Tamara García-Camarero, José Antonio Linares Vicente, Eva Rúmiz, Rosa María Cardenal Piris, Irene Elizondo Rua, Jean Paul Vilchez, Salvatore Brugaletta, Lara Fuentes, Ana Marcano, Pilar Carrillo, Álvaro Gabaldón, Armando Pérez de Prado, Joan Antoni Gómez-Hospital\",\"doi\":\"10.1016/j.rec.2025.05.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction and objectives: </strong>The reliability of quantitative flow ratio (QFR) has been questioned. 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引用次数: 0
摘要
简介和目的：定量流量比（QFR）的可靠性一直受到质疑。我们的目的是评估QFR在st段抬高型心肌梗死（STEMI）过程中对中间非罪魁祸首病变的诊断准确性，并与分期手术中基于正压丝的分数血流储备（FFR≤0.80）进行比较。方法：这是多中心、对照和随机的VULNERABLE试验的一项亚研究，包括388例连续STEMI患者的428个中间非罪魁祸首病变，在1至60天的分期过程中进行FFR评估。离线QFR分析在索引和分级过程中进行。主要目的是评估QFR指数与分期阳性FFR的诊断准确性。结果：血管造影血管直径（2.80±0.59 vs 2.91±0.57 mm）；P & lt;.01)，狭窄程度(51.33±8.04% vs 50.54±7.63%；P = 0.053)， QFR值(0.85±0.09 vs 0.86±0.09；P = .120)显示指数和分期手术之间的变化最小。指标QFR与分期FFR有中等程度的一致性(kappa指数= 0.629；类内相关系数= 0.641)。指标QFR预测FFR阳性的诊断准确率较好（曲线下面积= 0.825）。QFR指数截止值≤0.80，灵敏度中等（72%），特异度极佳（91%）。指数QFR≤0.87对于检测FFR阳性病变的灵敏度为86%，其中55%的病变在指数程序中QFR≤0.87。结论：指数QFR在分期诊断FFR阳性病变方面表现出良好的诊断准确性。然而，指数QFR截断值≤0.80表示中度敏感性，并且可能在FFR阳性的10个病变中有3个未被诊断。QFR指数≤0.87提供了更高的敏感性，并可能有助于避免许多患者的侵入性（分期）手术。
Diagnostic accuracy of quantitative flow ratio for nonculprit intermediate lesions in patients with ST-segment elevation myocardial infarction.
Introduction and objectives: The reliability of quantitative flow ratio (QFR) has been questioned. Our aim was to evaluate the diagnostic accuracy of QFR in intermediate nonculprit lesions during the index ST-segment elevation myocardial infarction (STEMI) procedure compared with positive pressure wire-based fractional flow reserve (FFR ≤0.80) in a staged procedure.
Methods: This was a substudy of the multicenter, controlled, and randomized VULNERABLE trial, including 428 intermediate nonculprit lesions from 388 consecutive STEMI patients undergoing FFR assessment in a staged procedure between 1 and 60 days. Off-line QFR analyses were performed during both the index and staged procedures. The primary objective was to assess the diagnostic accuracy of index QFR compared with staged positive FFR.
Results: Angiographic vessel diameter (2.80±0.59 vs 2.91±0.57mm; P<.01), stenosis severity (51.33±8.04% vs 50.54±7.63%; P=.053), and QFR values (0.85±0.09 vs 0.86±0.09; P=.120) showed minimal changes between the index and staged procedures. Moderate concordance was observed between index QFR and staged FFR (kappa index=0.629; intraclass correlation coefficient=0.641). The diagnostic accuracy of index QFR for predicting positive FFR was good (area under the curve=0.825). An index QFR cutoff ≤0.80 showed moderate sensitivity (72%) and excellent specificity (91%). An index QFR ≤0.87 achieved a sensitivity of 86% for detecting lesions with positive FFR, with 55% of lesions presenting QFR ≤0.87 at the index procedure.
Conclusions: Index QFR demonstrated good diagnostic accuracy for identifying lesions with positive FFR in a staged procedure. However, an index QFR cutoff value of ≤0.80 showed moderate sensitivity and may underdiagnose approximately 3 out of 10 lesions with positive FFR. An index QFR ≤0.87 provided higher sensitivity and may help avoid invasive (staged) procedures in many patients.
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