• Norihiro Kogame, Kuniaki Takahashi, Mariusz Tomaniak, Ply Chichareon, Rodrigo Modolo, Chun Chin Chang, Hidenori Komiyama, Yuki Katagiri, Taku Asano, Rod Stables, Farzin Fath-Ordoubadi, Simon Walsh, Manel Sabaté, Justin E Davies, Jan J Piek, Robert-Jan van Geuns, Reiber Johan H C JHC Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands., Adrian P Banning, Javier Escaned, Vasim Farooq, Patrick W Serruys, and Yoshinobu Onuma.
• Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Toho University medical center Ohashi hospital, Tokyo, Japan. Electronic address: https://twitter.com/KogameNorihiro.
• JACC Cardiovasc Interv. 2019 Oct 28; 12 (20): 2064-2075.

ObjectivesThe aim of this study was to investigate the impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) on clinical outcomes in patients with de novo 3-vessel disease (3VD) treated with contemporary PCI.BackgroundThe clinical impact of post-PCI QFR in patients treated with state-of-the-art PCI for de novo 3VD is undetermined.MethodsAll vessels treated in the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) II trial were retrospectively screened and analyzed for post-PCI QFR. The primary endpoint of this substudy was vessel-oriented composite endpoint (VOCE) at 2 years, defined as the composite of vessel-related cardiac death, vessel-related myocardial infarction, and target vessel revascularization. The receiver-operating characteristic curve was used to calculate the optimal cutoff value of post-PCI QFR for predicting 2-year VOCE. All the analyzable vessels were stratified on the basis of the optimal cutoff value.ResultsA total of 968 vessels treated with PCI were screened. Post-PCI QFR was analyzable in 771 (79.6%) vessels. A total of 52 (6.7%) VOCEs occurred at 2 years. The mean value of post-PCI QFR was 0.91 ± 0.07. The diagnostic performance of post-PCI QFR to predict 2-year VOCE was moderate (area under the curve: 0.702; 95% confidence interval: 0.633 to 0.772), with the optimal cutoff value of post-PCI QFR for predicting 2-year VOCE 0.91 (sensitivity 0.652, specificity 0.635). The incidence of 2-year VOCE in the vessels with post-PCI QFR <0.91 (n = 284) was significantly higher compared with vessels with post-PCI QFR ≥0.91 (n = 487) (12.0% vs. 3.7%; hazard ratio: 3.37; 95% confidence interval: 1.91 to 5.97; p < 0.001).ConclusionsA higher post-PCI QFR value is associated with improved vessel-related clinical outcomes in state-of-the art PCI practice for de novo 3VD. Achieving a post-PCI QFR value ≥0.91 in all treated vessels should be a target when treating de novo 3VD. These findings require confirmation in future prospective trials.Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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