Methods
death, pre-stenosis, stenosis
ADVERSE EVENTS, STENOSIS, STENOSES
We prospectively enrolled 198 multivessel diseased STEMI patients who were admitted to our center from July 2020 to June 2021 and had a non-culprit stenosis (35–75%).After giving their written consent, all included patients were randomized into one of two groups: (1) QFR-guided PCI (named QFR) and (2) visual estimation-only guided PCI (named Angio). Patient data, medical history, and medical treatment were collected from their medical records.All coronary artery angiographies (CAGs) were performed in compliance with the recommendation for QFR analysis as described in previous publications [Visual estimation was performed by a CAG performing doctor and discussed at the interventional cardiologists’ meeting. If any additional physiological evaluation was needed upon meeting the judgment, the patient was excluded from the study and treated following European Society of Cardiology (ESC) guidance.The quantitative flow ratio is an innovative method to evaluate the hemodynamic significance of coronary stenoses. The evaluation is based on two different angiographic projections. Special software was used to calculate the pressure differences between pre-stenosis and post-stenosis. In this study, stenoses were observed as hemodynamically significant when the QFR was less than 0,8. For those who were randomized to the QFR group, QFR analyses were performed using the same software - Medis Medical Imaging, Medis QFR® 20.0. All of the QFR analyses were performed offline twice by an experienced and internationally certified QFR observer and averaged. If those two measurements were not matching (the difference between the two measurements was > 0.02), the third measurement was performed, and the three were then averaged. None of the patients were unsuitable for QFR analyses; therefore, none of them were excluded from this group.For the QOL evaluation, the Seattle Angina Score Questionnaire (SASQ) was chosen (Additional File A 12-month follow-up was performed in all included patients as a phone call if there were any adverse events or complaints within this period. If the patient complained of any new or exacerbated cardiac symptoms, an in-person meeting and additional examination were scheduled.Patients who could not be reached by phone were mailed a letter addressing them or their relatives as provided on a written consent form. If any response within one month was obtained, they were checked on our hospital’s digital system for adverse events or death.The primary outcome involved in this study was mortality. Secondary outcomes: rehospitalization for culprit artery and non-culprit artery revascularization within the 12-month follow-up; and physical activity limitations (according to the SASQ) within the 12-month follow-up.Statistical analysis was performed using SPSS 28.0 software. The Kolmogorov-Smirnov test was used to test quantitative parameters; if they were normally distributed, differences between two groups were evaluated using the Student’s t-test and expressed as the mean with standard deviation (SD); otherwise, they were evaluated using the Mann-Whitney U test and expressed as the median with interquartile range (IQR). Differences between categorical parameters were tested using The study was approved by the Regional Bioethical Committee and was done according to the principles of the Helsinki Declaration and local laws and rules.