Functional Diagnostic Accuracy of Quantitative Flow Ratio in Tandem Lesions and Virtual Stenting

Inclusion Criteria:

• General inclusion Criteria:

1. Stable and unstable angina pectoris or secondary evaluation of stenosis afteracute MI;

2. Age > 18 years;

3. Able to provide signed informed consent.

• Angiographic inclusion criteria:

1. At least two localized lesions on the same coronary artery;

2. More than 50% diameter stenosis (DS) estimated by QCA on each lesion;

3. At least 10 mm relatively normal lumen (at most 20% DS) between two lesions;

4. Reference vessel size > 2 mm in stenotic segment by visual estimate.

Exclusion Criteria:

• General exclusion criteria:

1. Ineligible for diagnostic intervention or FFR examination;

2. Myocardial infarction within 72 hours;

3. Severe heart failure (NYHA≥III);

4. S-creatinine>150µmol/L or GFR<45 ml/kg/1.73m2;

5. Allergy to contrast agent or adenosine;

6. Factors that might substantially impact the angiographic image quality, e.g,frequent atrial premature beat or atrial fibrillation;

7. Serious complications:

8. Evidence of cardiac rupture;

9. History of bleeding (intracranial hemorrhage, gastrointestinal bleeding,etc.);

10. Acute or chronic blood system diseases, including hemoglobin < 10 g / L,or platelet count < 50 × 109 / L;

11. Accompanied by other diseases might inducing life expectancy shorter thanseveral months;

12. History of severe renal insufficiency and hypohepatia (liver failure,cirrhosis, portal hypertension and active hepatitis)

13. Aneurysm, arterial / venous malformation, aortic dissection;

14. Cardiogenic shock or circulation capacity failure;

15. Two-degree and more severe atrioventricular block, with no permanent pacemakerimplanted;

16. Pregnancy or lactation;

17. The investigators believe that the treatment regimen may be detrimental to thepatient or the enrollment of this subject may affect the specific assessment ofthe trial;

• Angiographic exclusion criteria:

1. The interrogated stenosis is caused by myocardial bridge;

2. Ostial lesions less than 3 mm to the aorta;

3. Side branches of the bifurcation lesions with Median Classification of 111 or 101;

4. Severe overlap or shorten of stenosis segment;

5. Severe tortuosity of target vessel;

6. Poor angiographic image quality precluding contour detection.