Predictive value of the QFR in detecting vulnerable plaques in non-flow limiting lesions: a combined analysis of the PROSPECT and IBIS-4 study.

Safi, Hannah; Bourantas, Christos V; Ramasamy, Anantharaman; Zanchin, Thomas; Bär, Sarah; Tufaro, Vincenzo; Jin, Chongying; Torii, Ryo; Karagiannis, Alexios; Reiber, Johan H C; Mathur, Anthony; Onuma, Yoshinubo; Windecker, Stephan; Lansky, Alexandra; Maehara, Akiko; Serruys, Patrick W; Stone, Peter; Baumbach, Andreas; Stone, Gregg W and Räber, Lorenz (2020). Predictive value of the QFR in detecting vulnerable plaques in non-flow limiting lesions: a combined analysis of the PROSPECT and IBIS-4 study. International journal of cardiovascular imaging, 36(6), pp. 993-1002. Springer 10.1007/s10554-020-01805-9

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Studies have shown that the quantitative flow ratio (QFR), recently introduced to assess lesion severity from coronary angiography, provides useful prognostic information; however the additive value of this technique over intravascular imaging in detecting lesions that are likely to cause events is yet unclear. We analysed data acquired in the PROSPECT and IBIS-4 studies, in particular the baseline virtual histology-intravascular ultrasound (VH-IVUS) and angiographic data from 17 non-culprit lesions with a presumable vulnerable phenotype (i.e., thin or thick cap fibroatheroma) that caused major adverse cardiac events or required revascularization (MACE) at 5-year follow-up and from a group of 78 vulnerable plaques that remained quiescent. The segments studied by VH-IVUS were identified in coronary angiography and the QFR was estimated. The additive value of 3-dimensional quantitative coronary angiography (3D-QCA) and of the QFR in predicting MACE at 5 year follow-up beyond plaque characteristics was examined. It was found that MACE lesions had a greater plaque burden (PB) and smaller minimum lumen area (MLA) on VH-IVUS, a longer length and a smaller minimum lumen diameter (MLD) on 3D-QCA and a lower QFR compared with lesions that remained quiescent. By univariate analysis MLA, PB, MLD, lesion length on 3D-QCA and QFR were predictors of MACE. In multivariate analysis a low but normal QFR (> 0.80 to < 0.97) was the only independent prediction of MACE (HR 3.53, 95% CI 1.16-10.75; P = 0.027). In non-flow limiting lesions with a vulnerable phenotype, QFR may provide additional prognostic information beyond plaque morphology for predicting MACE throughout 5 years.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Zanchin, Thomas, Bär, Sarah, Karagiannis Voules, Alexios, Windecker, Stephan, Räber, Lorenz


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services






[4] Swiss National Science Foundation




Andrea Flükiger-Flückiger

Date Deposited:

18 Mar 2020 12:15

Last Modified:

05 Dec 2022 15:37

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

QFR Quantitative coronary angiography Vulnerable plaque




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