Coronary disease & ACS

Quantitative Flow Ratio (QFR) Assessment and Prognosis After Nonculprit Percutaneous Coronary Intervention (PCI) in Patients With Acute Myocardial Infarction

JACC Cardiovasc IntervPublished Secondary analysis of the FRAME-AMI randomised trial

Primary result · MACEResult — go to the resultHazard ratio 4.13 95% CI 1.10–15.57

Authors' conclusion

In AMI patients with multivessel disease, 30.0% of angiography-guided PCI resulted in un-necessary PCI for the non-IRA with QFR >0.80, which was significantly associated with an increased risk of MACEs than in those with deferred PCI for non-IRA lesions.

Study context

Population
Acute myocardial infarction (AMI) patients with multivessel disease in the FRAME-AMI trial (fractional flow reserve (FFR)-guided vs angiography-guided non-IRA PCI)
Participants
443 patients552 lesions
Comparison
Non-IRA PCI despite QFR >0.80 vs deferred PCI for non-IRA lesions
Primary endpoint
Major adverse cardiac event (MACE):
  • Cardiac death
  • MI
  • Repeat revascularization
Follow-up
Median 3.5 years
Methodological detailspost hoc QFR analysis
  • Post hoc QFR analysis

Primary result

MACE · median 3.5 years

Hazard ratio

4.13

95% CI 1.10–15.57

P = 0.036

By group

Non-IRA PCI despite QFR >0.80vs Deferred PCI
HR 4.13 (95% CI 1.10–15.57); P = 0.036

As reported in the abstract

Further findings

OutcomeDeferred PCIHR (95% CI)P value
Non-IRA MACE · median 3.5 years2.1%5.44 (1.13–26.19)P = 0.035
  • Non-IRA PCI despite QFR >0.80 (proportion): Angiography-guided PCI 30.0%
  • Non-IRA PCI despite QFR >0.80 (proportion): FFR-guided PCI 2.7%
  • Non-IRA PCI despite QFR >0.80 (proportion): 209 patients in each group

Original publication

QFR Assessment and Prognosis After Nonculprit PCI in Patients With Acute Myocardial Infarction. JACC Cardiovasc Interv. Published 9 October 2023. doi:10.1016/j.jcin.2023.08.032

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