Clinical Value of Single-Projection Angiography-Derived FFR in Noninfarct-Related Artery

Abstract

BACKGROUND: The Murray law-based quantitative flow ratio (mu FR) is an emerging technique that requires only 1 projection of coronary angiography with similar accuracy to quantitative flow ratio (QFR). However, it has not been validated for the evaluation of noninfarct-related artery (non-IRA) in acute myocardial infarction (AMI) settings. Therefore, our study aimed to evaluate the diagnostic accuracy of mu FR and the safety of deferring non-IRA lesions with mu FR >0.80 in the setting of AMI. METHODS: mu FR and QFR were analyzed for non-IRA lesions of patients with AMI enrolled in the FRAME-AMI trial (Fractional Flow Reserve Versus Angiography-Guided Strategy for Management of Non-Infarction Related Artery Stenosis in Patients With Acute Myocardial Infarction), consisting of fractional flow reserve (FFR)-guided percutaneous coronary intervention and angiography-guided percutaneous coronary intervention groups. The diagnostic accuracy of mu FR was compared with QFR and FFR. Patients were classified by the non-IRA mu FR value of 0.80 as a cutoff value. The primary outcome was a vessel-oriented composite outcome, a composite of cardiac death, non-IRA-related myocardial infarction, and non-IRA-related repeat revascularization. RESULTS: mu FR and QFR analyses were feasible in 443 patients (552 lesions). mu FR showed acceptable correlation with FFR (R=0.777; P<0.001), comparable C-index with QFR to predict FFR <= 0.80 (mu FR versus QFR: 0.926 versus 0.961, P=0.070), and shorter total analysis time (mean, 32.7 versus 186.9 s; P<0.001). Non-IRA with mu FR >0.80 and deferred percutaneous coronary intervention had a significantly lower risk of vessel-oriented composite outcome than non-IRA with performed percutaneous coronary intervention (3.4% versus 10.5%; hazard ratio, 0.37 [95% CI, 0.14-0.99]; P=0.048). CONCLUSIONS: In patients with multivessel AMI, mu FR of non-IRA showed acceptable diagnostic accuracy comparable to that of QFR to predict FFR <= 0.80. Deferred non-IRA with mu FR >0.80 showed a lower risk of vessel-oriented composite outcome than revascularized non-IRA. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02715518.