Quantitative flow ratio to predict long-term coronary artery bypass graft patency in patients with left main coronary artery disease

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Abstract

Purpose

Fractional flow reserve (FFR) has been demonstrated in some studies to predict long-term coronary artery bypass graft (CABG) patency. Quantitative flow ratio (QFR) is an emerging technology which may predict FFR. In this study, we hypothesised that QFR would predict long-term CABG patency and that QFR would offer superior diagnostic performance to quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS).

Methods

A prospective study was performed on patients with left main coronary artery disease who were undergoing CABG. QFR, QCA and IVUS assessment was performed. Follow-up computed tomography coronary angiography and invasive coronary angiography was undertaken to assess graft patency.

Results

A total of 22 patients, comprising of 65 vessels were included in the analysis. At a median follow-up of 3.6 years post CABG (interquartile range, 2.3 to 4.8 years), 12 grafts (18.4%) were occluded. QFR was not statistically significantly higher in occluded grafts (0.81 ± 0.19 vs. 0.69 ± 0.21; P = 0.08). QFR demonstrated a discriminatory power to predict graft occlusion (area under the receiver operating characteristic curve, 0.70; 95% confidence interval [CI], 0.52 to 0.88; P = 0.03). At long-term follow-up, the risk of graft occlusion was higher in vessels with a QFR > 0.80 (58.6% vs. 17.0%; hazard ratio, 3.89; 95% CI, 1.05 to 14.42; P = 0.03 by log-rank test). QCA (minimum lumen diameter, lesion length, diameter stenosis) and IVUS (minimum lumen area, minimum lumen diameter, diameter stenosis) parameters were not predictive of long-term graft patency.

Conclusions

QFR may predict long-term graft patency in patients undergoing CABG.

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Most cited references 30

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Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.

Pim A.L. Tonino, Bernard De Bruyne, Nico H.J. Pijls … (2009)

In patients with multivessel coronary artery disease who are undergoing percutaneous coronary intervention (PCI), coronary angiography is the standard method for guiding the placement of the stent. It is unclear whether routine measurement of fractional flow reserve (FFR; the ratio of maximal blood flow in a stenotic artery to normal maximal flow), in addition to angiography, improves outcomes. In 20 medical centers in the United States and Europe, we randomly assigned 1005 patients with multivessel coronary artery disease to undergo PCI with implantation of drug-eluting stents guided by angiography alone or guided by FFR measurements in addition to angiography. Before randomization, lesions requiring PCI were identified on the basis of their angiographic appearance. Patients assigned to angiography-guided PCI underwent stenting of all indicated lesions, whereas those assigned to FFR-guided PCI underwent stenting of indicated lesions only if the FFR was 0.80 or less. The primary end point was the rate of death, nonfatal myocardial infarction, and repeat revascularization at 1 year. The mean (+/-SD) number of indicated lesions per patient was 2.7+/-0.9 in the angiography group and 2.8+/-1.0 in the FFR group (P=0.34). The number of stents used per patient was 2.7+/-1.2 and 1.9+/-1.3, respectively (P<0.001). The 1-year event rate was 18.3% (91 patients) in the angiography group and 13.2% (67 patients) in the FFR group (P=0.02). Seventy-eight percent of the patients in the angiography group were free from angina at 1 year, as compared with 81% of patients in the FFR group (P=0.20). Routine measurement of FFR in patients with multivessel coronary artery disease who are undergoing PCI with drug-eluting stents significantly reduces the rate of the composite end point of death, nonfatal myocardial infarction, and repeat revascularization at 1 year. (ClinicalTrials.gov number, NCT00267774.) 2009 Massachusetts Medical Society

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Fractional Flow Reserve–Guided PCI versus Medical Therapy in Stable Coronary Disease

Bernard De Bruyne, Nico H.J. Pijls, Bindu Kalesan … (2012)

The preferred initial treatment for patients with stable coronary artery disease is the best available medical therapy. We hypothesized that in patients with functionally significant stenoses, as determined by measurement of fractional flow reserve (FFR), percutaneous coronary intervention (PCI) plus the best available medical therapy would be superior to the best available medical therapy alone. In patients with stable coronary artery disease for whom PCI was being considered, we assessed all stenoses by measuring FFR. Patients in whom at least one stenosis was functionally significant (FFR, ≤0.80) were randomly assigned to FFR-guided PCI plus the best available medical therapy (PCI group) or the best available medical therapy alone (medical-therapy group). Patients in whom all stenoses had an FFR of more than 0.80 were entered into a registry and received the best available medical therapy. The primary end point was a composite of death, myocardial infarction, or urgent revascularization. Recruitment was halted prematurely after enrollment of 1220 patients (888 who underwent randomization and 332 enrolled in the registry) because of a significant between-group difference in the percentage of patients who had a primary end-point event: 4.3% in the PCI group and 12.7% in the medical-therapy group (hazard ratio with PCI, 0.32; 95% confidence interval [CI], 0.19 to 0.53; P<0.001). The difference was driven by a lower rate of urgent revascularization in the PCI group than in the medical-therapy group (1.6% vs. 11.1%; hazard ratio, 0.13; 95% CI, 0.06 to 0.30; P<0.001); in particular, in the PCI group, fewer urgent revascularizations were triggered by a myocardial infarction or evidence of ischemia on electrocardiography (hazard ratio, 0.13; 95% CI, 0.04 to 0.43; P<0.001). Among patients in the registry, 3.0% had a primary end-point event. In patients with stable coronary artery disease and functionally significant stenoses, FFR-guided PCI plus the best available medical therapy, as compared with the best available medical therapy alone, decreased the need for urgent revascularization. In patients without ischemia, the outcome appeared to be favorable with the best available medical therapy alone. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT01132495.).

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Five-Year Outcomes with PCI Guided by Fractional Flow Reserve

Axel Linke, Petr Kala, Ole Fröbert … (2018)

We hypothesized that fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) would be superior to medical therapy as initial treatment in patients with stable coronary artery disease.

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Author and article information

Contributors

Cameron Dowling:

ORCID: http://orcid.org/0000-0003-3191-5361

cameron.dowling@monashhealth.org

Journal

Journal ID (nlm-ta): Int J Cardiovasc Imaging

Journal ID (iso-abbrev): Int J Cardiovasc Imaging

Title: The International Journal of Cardiovascular Imaging

Publisher: Springer Netherlands (Dordrecht )

ISSN (Print): 1569-5794

ISSN (Electronic): 1875-8312

Publication date (Electronic): 28 August 2022

Publication date PMC-release: 28 August 2022

Publication date (Print): 2022

Volume: 38

Issue: 12

Pages: 2811-2818

Affiliations

[1 ]GRID grid.1002.3, ISNI 0000 0004 1936 7857, MonashHeart, Monash Health and Monash Cardiovascular Research Centre, , Monash University, ; Melbourne, Australia

[2 ]GRID grid.168010.e, ISNI 0000000419368956, Division of Cardiovascular Medicine, , Stanford University School of Medicine, ; Stanford, CA USA

[3 ]GRID grid.26009.3d, ISNI 0000 0004 1936 7961, Duke Clinical Research Institute, , Duke University, ; Durham, NC USA

[4 ]GRID grid.1002.3, ISNI 0000 0004 1936 7857, Department of Cardiothoracic Surgery, Monash Health and Department of Surgery (School of Clinical Sciences at Monash Health), , Monash University, ; Melbourne, Australia

[5 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Department of Cardiology, Westmead Hospital and Westmead Applied Research Centre, , University of Sydney, ; Sydney, Australia

[6 ]GRID grid.1002.3, ISNI 0000 0004 1936 7857, School of Clinical Sciences at Monash Health, , Monash University, ; Melbourne, Australia

[7 ]MonashHeart, 246 Clayton Rd, Clayton, VIC 3168 Australia

Author information

Cameron Dowling http://orcid.org/0000-0003-3191-5361

Article

Publisher ID: 2699

DOI: 10.1007/s10554-022-02699-5

PMC ID: 9708783

PubMed ID: 36445675

SO-VID: a9115949-38ca-4bd8-99cd-a24e8f23a947

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 22 May 2022

Date accepted : 20 July 2022

Funding

Funded by: Monash University

Open Access :

Open Access funding enabled and organized by CAUL and its Member Institutions

Custom metadata

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: coronary artery bypass grafting,graft occlusion,computed tomography coronary angiography,quantitative flow reserve

Data availability:

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: coronary artery bypass grafting, graft occlusion, computed tomography coronary angiography, quantitative flow reserve

Quantitative flow ratio to predict long-term coronary artery bypass graft patency in patients with left main coronary artery disease

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Cardiovascular Innovations and Applications

Most cited references 30

Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.

Fractional Flow Reserve–Guided PCI versus Medical Therapy in Stable Coronary Disease

Five-Year Outcomes with PCI Guided by Fractional Flow Reserve

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