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Nonculprit Stenosis Evaluation Using Instantaneous Wave-Free Ratio in Patients With ST-Segment Elevation Myocardial Infarction
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Cardiology, Lund University, Skåne University Hospital, Lund, Sweden.
Örebro University, School of Medical Sciences. Department of Cardiology.
Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
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2017 (English)In: JACC: Cardiovascular Interventions, ISSN 1936-8798, E-ISSN 1876-7605, Vol. 10, no 24, 2528-2535 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aim of this study was to examine the level of agreement between acute instantaneous wave-free ratio (iFR) measured across nonculprit stenoses in patients with ST-segment elevation myocardial infarction (STEMI) and iFR measured at a staged follow-up procedure.

BACKGROUND: Acute full revascularization of nonculprit stenoses in STEMI is debated and currently guided by angiography. Acute functional assessment of nonculprit stenoses may be considered.

METHODS: Immediately after successful primary culprit intervention for STEMI, nonculprit coronary stenoses were evaluated with iFR and left untreated. Follow-up evaluation with iFR was performed at a later stage. iFR <0.90 was considered hemodynamically significant.

RESULTS: One hundred twenty patients with 157 nonculprit lesions were included. Median acute iFR was 0.89 (interquartile range: 0.82 to 0.94; n = 156), and median follow-up iFR was 0.91 (interquartile range [IQR]: 0.86 to 0.96; n = 147). Classification agreement was 78% between acute and follow-up iFR. The negative predictive value of acute iFR was 89%. Median time from acute to follow-up evaluation was 16 days (IQR: 5 to 32 days). With follow-up within 5 days after STEMI, no difference was observed between acute and follow-up iFR, and classification agreement was 89%. With follow-up ≥16 days after STEMI, acute iFR was lower than follow-up iFR, and classification agreement was 70%.

CONCLUSIONS: Acute iFR evaluation appeared valid for ruling out significant nonculprit stenoses in patients with STEMI undergoing primary percutaneous coronary intervention. The time interval from acute to follow-up iFR influenced classification agreement, suggesting that inherent physiological disarrangements during STEMI may contribute to classification disagreement.

Place, publisher, year, edition, pages
New York, USA: Elsevier, 2017. Vol. 10, no 24, 2528-2535 p.
Keyword [en]
Complete primary revascularization, FFR, full revascularization, iFR, primary PCI
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-63019DOI: 10.1016/j.jcin.2017.07.021ISI: 000418483200011PubMedID: 29198461OAI: oai:DiVA.org:oru-63019DiVA: diva2:1163599
Note

Funding Agencies:

Volcano Europe BVBA/SPRL

Netherlands Organisation for Health Research and Development 90714544 

Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2018-01-10Bibliographically approved

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Fröbert, Ole

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