Validation of angiography-based FFR in non-culprit vessels of patients presenting with STEMI

Jari A. van der Eijk; Frederik T.W. Groenland; Alessandra Scoccia; Annemieke C. Ziedses des Plantes; Jager Huang; Rutger Jan Nuis; Jeroen M. Wilschut; Wijnand K. den Dekker; Roberto Diletti; Isabella Kardys; Mariusz Tomaniak; Nicolas M. Van Mieghem; Joost Daemen

doi:10.1007/s00392-025-02729-x

Validation of angiography-based FFR in non-culprit vessels of patients presenting with STEMI

^*Corresponding author for this work

Erasmus University Rotterdam
Medical University of Warsaw

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Abstract

Background:

Fractional flow reserve (FFR) for non-culprit lesions (NCLs) in patients with ST-elevation myocardial infarction (STEMI) can be influenced by temporary changes in microvascular resistance. Angiography-derived vessel fractional flow reserve (vFFR) has been tested as a less-invasive alternative. Aims: The FAST STEMI II study aimed to assess the diagnostic performance of acute-setting vFFR vs. FFR for intermediate NCLs in STEMI patients.

Methods:

FAST STEMI II is a prospective two-center cohort study including STEMI patients with ≥ 1 intermediate NCL (50–90% diameter stenosis). Patients with cardiogenic shock, prior revascularization of the non-culprit vessel, or aorta-ostial lesions were excluded. Following primary percutaneous coronary intervention (PCI), vFFR, FFR, resting full-cycle ratio (RFR), coronary flow reserve (CFR), and index of microcirculatory resistance (IMR) measurements of the NCL were performed.

Results:

A total of 111 patients were included. Median [25th–75th percentile] vFFR and FFR were 0.83 [0.74–0.88] and 0.83 [0.80–0.90], respectively. vFFR had a moderate to good discriminative ability to predict FFR ≤ 0.80 (AUC: 0.78; 95% CI: 0.68–0.89; p < 0.001) with a moderate correlation (r = 0.54; p < 0.001). Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of vFFR to predict FFR ≤ 0.80 were 72%, 76%, 70%, 53%, and 87%, respectively. Microvascular dysfunction (CFR < 2.0 and IMR ≥ 25) was observed in 33 (31%) patients. In patients with microvascular dysfunction, median vFFR and FFR values were 0.76 [0.71–0.86] and 0.85 [0.77–0.90], respectively (p = 0.002).

Conclusions:

We found moderate correlation between vFFR and FFR in NCLs of patients undergoing primary PCI. Discordance between vFFR and FFR was associated with the presence of microvascular dysfunction. The study was conducted in accordance with Good Clinical Practice and the Declaration of Helsinki and was registered at 22-jun-2023 on clinicaltrials.gov under the identifier NCT05698719.

Original language	English
Journal	Clinical Research in Cardiology
DOIs	https://doi.org/10.1007/s00392-025-02729-x
Publication status	Published - 8 Sept 2025

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Publisher Copyright:
© The Author(s) 2025.

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Validation of angiography-based FFR in non-culprit vessels of patients presenting with STEMIFinal published version, 1.29 MBLicence: CC BY

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van der Eijk, J. A., Groenland, F. T. W., Scoccia, A., Ziedses des Plantes, A. C., Huang, J., Nuis, R. J., Wilschut, J. M., den Dekker, W. K., Diletti, R., Kardys, I., Tomaniak, M., Van Mieghem, N. M., & Daemen, J. (2025). Validation of angiography-based FFR in non-culprit vessels of patients presenting with STEMI. Clinical Research in Cardiology. https://doi.org/10.1007/s00392-025-02729-x

@article{afc077bf025147d3acceda5a5fe85ba3,

title = "Validation of angiography-based FFR in non-culprit vessels of patients presenting with STEMI",

abstract = "Background: Fractional flow reserve (FFR) for non-culprit lesions (NCLs) in patients with ST-elevation myocardial infarction (STEMI) can be influenced by temporary changes in microvascular resistance. Angiography-derived vessel fractional flow reserve (vFFR) has been tested as a less-invasive alternative. Aims: The FAST STEMI II study aimed to assess the diagnostic performance of acute-setting vFFR vs. FFR for intermediate NCLs in STEMI patients. Methods: FAST STEMI II is a prospective two-center cohort study including STEMI patients with ≥ 1 intermediate NCL (50–90\% diameter stenosis). Patients with cardiogenic shock, prior revascularization of the non-culprit vessel, or aorta-ostial lesions were excluded. Following primary percutaneous coronary intervention (PCI), vFFR, FFR, resting full-cycle ratio (RFR), coronary flow reserve (CFR), and index of microcirculatory resistance (IMR) measurements of the NCL were performed. Results: A total of 111 patients were included. Median [25th–75th percentile] vFFR and FFR were 0.83 [0.74–0.88] and 0.83 [0.80–0.90], respectively. vFFR had a moderate to good discriminative ability to predict FFR ≤ 0.80 (AUC: 0.78; 95\% CI: 0.68–0.89; p < 0.001) with a moderate correlation (r = 0.54; p < 0.001). Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of vFFR to predict FFR ≤ 0.80 were 72\%, 76\%, 70\%, 53\%, and 87\%, respectively. Microvascular dysfunction (CFR < 2.0 and IMR ≥ 25) was observed in 33 (31\%) patients. In patients with microvascular dysfunction, median vFFR and FFR values were 0.76 [0.71–0.86] and 0.85 [0.77–0.90], respectively (p = 0.002). Conclusions: We found moderate correlation between vFFR and FFR in NCLs of patients undergoing primary PCI. Discordance between vFFR and FFR was associated with the presence of microvascular dysfunction. The study was conducted in accordance with Good Clinical Practice and the Declaration of Helsinki and was registered at 22-jun-2023 on clinicaltrials.gov under the identifier NCT05698719.",

author = "\{van der Eijk\}, \{Jari A.\} and Groenland, \{Frederik T.W.\} and Alessandra Scoccia and \{Ziedses des Plantes\}, \{Annemieke C.\} and Jager Huang and Nuis, \{Rutger Jan\} and Wilschut, \{Jeroen M.\} and \{den Dekker\}, \{Wijnand K.\} and Roberto Diletti and Isabella Kardys and Mariusz Tomaniak and \{Van Mieghem\}, \{Nicolas M.\} and Joost Daemen",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

month = sep,

day = "8",

doi = "10.1007/s00392-025-02729-x",

language = "English",

journal = "Clinical Research in Cardiology",

issn = "1861-0684",

publisher = "Springer Science+Business Media",

}

TY - JOUR

T1 - Validation of angiography-based FFR in non-culprit vessels of patients presenting with STEMI

AU - van der Eijk, Jari A.

AU - Groenland, Frederik T.W.

AU - Scoccia, Alessandra

AU - Ziedses des Plantes, Annemieke C.

AU - Huang, Jager

AU - Nuis, Rutger Jan

AU - Wilschut, Jeroen M.

AU - den Dekker, Wijnand K.

AU - Diletti, Roberto

AU - Kardys, Isabella

AU - Tomaniak, Mariusz

AU - Van Mieghem, Nicolas M.

AU - Daemen, Joost

PY - 2025/9/8

Y1 - 2025/9/8

N2 - Background: Fractional flow reserve (FFR) for non-culprit lesions (NCLs) in patients with ST-elevation myocardial infarction (STEMI) can be influenced by temporary changes in microvascular resistance. Angiography-derived vessel fractional flow reserve (vFFR) has been tested as a less-invasive alternative. Aims: The FAST STEMI II study aimed to assess the diagnostic performance of acute-setting vFFR vs. FFR for intermediate NCLs in STEMI patients. Methods: FAST STEMI II is a prospective two-center cohort study including STEMI patients with ≥ 1 intermediate NCL (50–90% diameter stenosis). Patients with cardiogenic shock, prior revascularization of the non-culprit vessel, or aorta-ostial lesions were excluded. Following primary percutaneous coronary intervention (PCI), vFFR, FFR, resting full-cycle ratio (RFR), coronary flow reserve (CFR), and index of microcirculatory resistance (IMR) measurements of the NCL were performed. Results: A total of 111 patients were included. Median [25th–75th percentile] vFFR and FFR were 0.83 [0.74–0.88] and 0.83 [0.80–0.90], respectively. vFFR had a moderate to good discriminative ability to predict FFR ≤ 0.80 (AUC: 0.78; 95% CI: 0.68–0.89; p < 0.001) with a moderate correlation (r = 0.54; p < 0.001). Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of vFFR to predict FFR ≤ 0.80 were 72%, 76%, 70%, 53%, and 87%, respectively. Microvascular dysfunction (CFR < 2.0 and IMR ≥ 25) was observed in 33 (31%) patients. In patients with microvascular dysfunction, median vFFR and FFR values were 0.76 [0.71–0.86] and 0.85 [0.77–0.90], respectively (p = 0.002). Conclusions: We found moderate correlation between vFFR and FFR in NCLs of patients undergoing primary PCI. Discordance between vFFR and FFR was associated with the presence of microvascular dysfunction. The study was conducted in accordance with Good Clinical Practice and the Declaration of Helsinki and was registered at 22-jun-2023 on clinicaltrials.gov under the identifier NCT05698719.

AB - Background: Fractional flow reserve (FFR) for non-culprit lesions (NCLs) in patients with ST-elevation myocardial infarction (STEMI) can be influenced by temporary changes in microvascular resistance. Angiography-derived vessel fractional flow reserve (vFFR) has been tested as a less-invasive alternative. Aims: The FAST STEMI II study aimed to assess the diagnostic performance of acute-setting vFFR vs. FFR for intermediate NCLs in STEMI patients. Methods: FAST STEMI II is a prospective two-center cohort study including STEMI patients with ≥ 1 intermediate NCL (50–90% diameter stenosis). Patients with cardiogenic shock, prior revascularization of the non-culprit vessel, or aorta-ostial lesions were excluded. Following primary percutaneous coronary intervention (PCI), vFFR, FFR, resting full-cycle ratio (RFR), coronary flow reserve (CFR), and index of microcirculatory resistance (IMR) measurements of the NCL were performed. Results: A total of 111 patients were included. Median [25th–75th percentile] vFFR and FFR were 0.83 [0.74–0.88] and 0.83 [0.80–0.90], respectively. vFFR had a moderate to good discriminative ability to predict FFR ≤ 0.80 (AUC: 0.78; 95% CI: 0.68–0.89; p < 0.001) with a moderate correlation (r = 0.54; p < 0.001). Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of vFFR to predict FFR ≤ 0.80 were 72%, 76%, 70%, 53%, and 87%, respectively. Microvascular dysfunction (CFR < 2.0 and IMR ≥ 25) was observed in 33 (31%) patients. In patients with microvascular dysfunction, median vFFR and FFR values were 0.76 [0.71–0.86] and 0.85 [0.77–0.90], respectively (p = 0.002). Conclusions: We found moderate correlation between vFFR and FFR in NCLs of patients undergoing primary PCI. Discordance between vFFR and FFR was associated with the presence of microvascular dysfunction. The study was conducted in accordance with Good Clinical Practice and the Declaration of Helsinki and was registered at 22-jun-2023 on clinicaltrials.gov under the identifier NCT05698719.

UR - https://www.scopus.com/pages/publications/105015430550

U2 - 10.1007/s00392-025-02729-x

DO - 10.1007/s00392-025-02729-x

M3 - Article

C2 - 40924133

AN - SCOPUS:105015430550

SN - 1861-0684

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

ER -

Validation of angiography-based FFR in non-culprit vessels of patients presenting with STEMI

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