Abstract：
BACKGROUND: The role of quantitative flow ratio (QFR) in the treatment of nonculprit vessels of patients with myocardial infarction (MI) is a topic of ongoing discussion.
OBJECTIVE: This study aimed to investigate the predictive capability of QFR for adverse events and its noninferiority compared to wire-based functional assessment in nonculprit vessels of MI patients.
METHODS: The FIRE (Functional Assessment in Elderly MI Patients With Multivessel Disease) trial randomized 1,445 older MI patients to culprit-only (n = 725) or physiology-guided complete revascularization (n = 720). In the culprit-only arm, angiographic projections of nonculprit vessels were prospectively collected, centrally reviewed for QFR computation, and associated with endpoints. In the complete revascularization arm, endpoints were compared between nonculprit vessels investigated with QFR or wire-based functional assessment. The primary endpoint was the vessel-oriented composite endpoint (VOCE) at 1 year.
RESULTS: QFR was measured on 903 nonculprit vessels from 685 patients in the culprit-only arm. Overall, 366 (40.5%) nonculprit vessels showed a QFR value ≤0.80, with a significantly higher incidence of VOCEs (22.1% vs 7.1%; P < 0.001). QFR ≤0.80 emerged as an independent predictor of VOCEs (HR: 2.79; 95% CI: 1.64-4.75). In the complete arm, QFR was used in 320 (35.2%) nonculprit vessels to guide revascularization. When compared with propensity-matched nonculprit vessels in which treatment was guided by wire-based functional assessment, no significant difference was observed (HR: 0.57; 95% CI: 0.28-1.15) in VOCEs.
CONCLUSIONS: This prespecified subanalysis of the FIRE trial provides evidence supporting the safety and efficacy of QFR-guided interventions for the treatment of nonculprit vessels in MI patients. (Functional Assessment in Elderly MI Patients With Multivessel Disease [FIRE]; NCT03772743).
OBJECTIVE: This study aimed to investigate the predictive capability of QFR for adverse events and its noninferiority compared to wire-based functional assessment in nonculprit vessels of MI patients.
METHODS: The FIRE (Functional Assessment in Elderly MI Patients With Multivessel Disease) trial randomized 1,445 older MI patients to culprit-only (n = 725) or physiology-guided complete revascularization (n = 720). In the culprit-only arm, angiographic projections of nonculprit vessels were prospectively collected, centrally reviewed for QFR computation, and associated with endpoints. In the complete revascularization arm, endpoints were compared between nonculprit vessels investigated with QFR or wire-based functional assessment. The primary endpoint was the vessel-oriented composite endpoint (VOCE) at 1 year.
RESULTS: QFR was measured on 903 nonculprit vessels from 685 patients in the culprit-only arm. Overall, 366 (40.5%) nonculprit vessels showed a QFR value ≤0.80, with a significantly higher incidence of VOCEs (22.1% vs 7.1%; P < 0.001). QFR ≤0.80 emerged as an independent predictor of VOCEs (HR: 2.79; 95% CI: 1.64-4.75). In the complete arm, QFR was used in 320 (35.2%) nonculprit vessels to guide revascularization. When compared with propensity-matched nonculprit vessels in which treatment was guided by wire-based functional assessment, no significant difference was observed (HR: 0.57; 95% CI: 0.28-1.15) in VOCEs.
CONCLUSIONS: This prespecified subanalysis of the FIRE trial provides evidence supporting the safety and efficacy of QFR-guided interventions for the treatment of nonculprit vessels in MI patients. (Functional Assessment in Elderly MI Patients With Multivessel Disease [FIRE]; NCT03772743).
摘要：
背景：定量流量比（QFR）在心肌梗死（MI）患者非罪犯血管治疗中的作用是一个正在进行讨论的话题。
目的：本研究旨在探讨QFR对MI患者非罪犯血管不良事件的预测能力及其与基于导线的功能评估相比的非劣效性。
方法：FIRE（老年MI患者多支血管疾病的功能评估）试验将1,445名老年MI患者随机分为仅发病（n=725）或生理学指导的完全血运重建（n=720）。只有罪犯的手臂，前瞻性地收集了非罪犯血管的血管造影投影，集中审查QFR计算，并与端点相关联。在完整的血运重建组中，在使用QFR或基于导线的功能评估进行调查的非罪犯血管之间比较了终点。主要终点是1年时的血管定向复合终点（VOCE）。
结果：QFR是在仅罪犯臂的685名患者的903名非罪犯血管上测量的。总的来说,366（40.5%）非罪犯血管的QFR值≤0.80，VOCEs的发生率明显较高（22.1%vs7.1%；P<0.001）。QFR≤0.80是VOCEs的独立预测因子（HR：2.79；95%CI：1.64-4.75）。在完整的手臂中，在320（35.2％）非罪犯血管中使用QFR来指导血运重建。当与倾向匹配的非罪犯血管相比时，治疗是通过基于导线的功能评估引导的，在VOCEs中没有观察到显著差异(HR:0.57;95%CI:0.28-1.15)。
结论：FIRE试验的这一预设亚分析提供了证据支持QFR指导干预措施治疗MI患者非罪犯血管的安全性和有效性。(患有多支血管疾病的老年MI患者的功能评估[FIRE];NCT03772743)。
目的：本研究旨在探讨QFR对MI患者非罪犯血管不良事件的预测能力及其与基于导线的功能评估相比的非劣效性。
方法：FIRE（老年MI患者多支血管疾病的功能评估）试验将1,445名老年MI患者随机分为仅发病（n=725）或生理学指导的完全血运重建（n=720）。只有罪犯的手臂，前瞻性地收集了非罪犯血管的血管造影投影，集中审查QFR计算，并与端点相关联。在完整的血运重建组中，在使用QFR或基于导线的功能评估进行调查的非罪犯血管之间比较了终点。主要终点是1年时的血管定向复合终点（VOCE）。
结果：QFR是在仅罪犯臂的685名患者的903名非罪犯血管上测量的。总的来说,366（40.5%）非罪犯血管的QFR值≤0.80，VOCEs的发生率明显较高（22.1%vs7.1%；P<0.001）。QFR≤0.80是VOCEs的独立预测因子（HR：2.79；95%CI：1.64-4.75）。在完整的手臂中，在320（35.2％）非罪犯血管中使用QFR来指导血运重建。当与倾向匹配的非罪犯血管相比时，治疗是通过基于导线的功能评估引导的，在VOCEs中没有观察到显著差异(HR:0.57;95%CI:0.28-1.15)。
结论：FIRE试验的这一预设亚分析提供了证据支持QFR指导干预措施治疗MI患者非罪犯血管的安全性和有效性。(患有多支血管疾病的老年MI患者的功能评估[FIRE];NCT03772743)。
