Quantitative flow ratio (QFR) demonstrated substantial applicability in patients with three-vessel disease (3VD) based on new research published in JACC: Interventions and presented at TCT 2018. Researchers led by Taku Asano, MD, et al., also remarked that the functional SYNTAX score derived from QFR (fSS_QFR) "has the potential to further refine prognostic risk estimation as compared with classic anatomical SYNTAX score."

Asano and colleagues retrospectively screened an analyzed all the lesions interrogated with instantaneous wave-free ratio (iFR) and/or fractional flow reserve (FFR) in the SYNTAX II trial for QFR. Patients with analyzable QFR in three vessels were stratified according to fSS_QFR to evaluate its clinical prognostic value based on two-year patient-oriented composite endpoint.

Of the 836 lesions, QFRs were analyzable in 71.0 percent. Researchers noted the diagnostic performance of QFR to predict binary wire-based ischemia "was substantial" with a positive predictive value of 85.9 percent. Independent predictors for diagnostic discordance were lesions in side branches, involvement of ibifurcation/trifurcation and small vessel. At the two-year patient-oriented composite endpoint, fSS_QFR appropriately reclassified 26.1 percent of patients at high/intermediate risk to low-risk (net reclassification improvement 0.32, P<0.001) – higher than that of classic anatomical SYNTAX score (0.68 vs 0.56, P=0.002).

"The functional SYNTAX score derived from QFR has the potential to further refine the prognostic risk estimation in a less-invasive fashion," the researchers said. They added that further investigations into the "impact of the fSS_QFR on the treatment decision of a heart team for patients with 3VD using angiographic acquisition guideline for QFR" are warranted.

Keywords: TCT18, Transcatheter Cardiovascular Therapeutics

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