CL_I_L: Clinical Medicine I. Lectures
Zsolt Piróth MD PhD1, Gábor Fülöp MD1, Bianca M. Boxma-de Klerk PhD2, Elmir Omerovic MD3, Péter Andréka MD, PhD1, Géza Fontos MD1, Franz-Josef Neumann, MD4, Gert Richardt, MD, PhD5, Mohammad Abdelghani MD PhD6, Pieter C. Smits, MD, PhD2
1 Department of Cardiology, Gottsegen National Cardiovascular Institute, Budapest, Hungary,
2 Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, The Netherlands,
3 Department of Cardiology, Gothenburg University Hospital, Gothenburg, Sweden,
4 Department of Cardiology, University Heart Center Freiburg– Bad Krozingen, Bad Krozingen, Germany,
5 Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany,
6 Amsterdam UMC, University of Amsterdam, The Netherlands
Aims: We aimed to study the applicability of resting indices to guide non-infarct related artery (nIRA) revascularization in ST-elevation myocardial infarction (STEMI).
Method: We analyzed the correlation and prognostic value of Fractional Flow Reserve (FFR) and resting distal coronary to aortic pressure ratio (Pd/Pa) in all patients of the Compare-Acute trial in whom, after successful primary percutaneous coronary intervention (PCI), the nIRA was interrogated by both and treated medically. The treating cardiologist was blinded to these values. The primary end-point was the composite of target vessel (TV: interrogated nIRA) related non-fatal myocardial infarction (TVMI) and TV repeat revascularization (TVR) at 36 months.
Results: 674 patients (851 vessels) were included. On receiver-operating characteristic analysis, the optimal Pd/Pa cut-off for FFR ≤0.80 was 0.905 (C statistic: 0.897). The diagnostic accuracy of Pd/Pa was 80.26% (95% confidence interval (CI), 77.42-82.88%) with respect to FFR. During the 36-month follow-up, 147 TVR and 20 TVMI occurred. FFR and Pd/Pa had a diagnostic accuracy to predict these events of 68.98% (95% CI, 65.75-72.07%) and 60.99% (95% CI, 57.62-64.28%), respectively (p=0.08). When they were discrepant, FFR was significantly better than Pd/Pa in identifying which vessels could be safely deferred (p=0.018).
Conclusion: Immediately after successful primary PCI, resting Pd/Pa has a diagnostic accuracy of 80% with respect to FFR measured in the nIRA. FFR is not significantly superior in predicting TVMI and TVR during 36 months of follow-up but, in case FFR and Pd/Pa are discrepant, FFR is superior in choosing non-culprit lesions to be deferred.
Funding: The study was supported by the ÚNKP-20-4-II-SE-10 New National Excellence Program of the Ministry for Innovation and Technology from the source of the National Research, Development and Innovation Fund, Hungary.
Semmelweis University, Károly Rácz Doctoral School of Clinical Medicine