PCI Using QFR Guidance in Non-Culprit Lesions Post-STEMI May Improve Survival

Quantitative flow ratio (QFR)-guided percutaneous coronary intervention (PCI) for non-culprit lesions is associated with reduced mortality compared with angiography-only-guided PCI among patients with ST-elevation myocardial infarction (STEMI). These findings were published in BMC Cardiovascular Disorders.

This study recruited patients (N=198) with multivessel STEMI and non-culprit stenosis of 35% to 75% from the Hospital of Lithuanian University of Health Sciences between 2020 and 2021. The patients were randomly assigned to receive QFR-guided PCI (n=98) or visual estimation-only-guided PCI (n=100) treatment for non-culprit lesions. The primary outcome was mortality, which was evaluated by telephone call or mailed letter at 12 months.

The study population included patients with a mean age of 65.0 (SD, 10.60) years, 70.7% were men, 52.5% had an inferior myocardial infarction (MI), 15.7% had a history of PCI, 8.1% had a history of MI, and 3.0% had in-hospital mortality. All in-hospital mortality events occurred among the angiography-guided group (P =.046).

At follow-up, 42.4% of patients had minimal, 47.5% had mild, and 4.0% had moderate physical limitations per the Seattle Angina Score Questionnaire.

The QFR recipients had a greater change in left ventricular ejection fraction at 6 months (mean difference, 3.97% vs -0.06%; P =.041) and fewer received additional non-culprit artery revascularization at 12 months (1.0% vs 6.0%; P =.047) compared with the angiography cohort.

The mortality rate during the 12-month follow-up was lower for the QFR group (2.04%) compared with the angiography group (12%). These values indicated that QFR-guided PCI was associated with decreased risk of mortality (odds ratio [OR], 6.23; 95% CI, 2.20-17.87; P =.006).

The limitations of this study include the small sample size and the significant differences between groups at baseline.

“The QFR is a noninvasive coronary physiology evaluation method that is accurate for STEMI patients and can be performed by any qualified team member,” the study authors wrote. “The use of QFR for patients with ST-elevation myocardial infarction significantly reduced the mortality rate and revascularization at the 12-month follow-up.”