State Key Laboratory of Cardiovascular Disease, Beijing, China; Cardiometabolic Medicine Center, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Diabetes Res Clin Pract. 2022 Apr;186:109839. doi: 10.1016/j.diabres.2022.109839. Epub 2022 Mar 21.
To compare the prognostic implication of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) assessment in patients with and without diabetes enrolled in the all-comers, multicenter, randomized controlled PANDA III trial.
All treated vessels in PANDA III trial were retrospectively assessed for post-PCI QFR. Vessels with available post-PCI QFR were further stratified into DM and non-DM cohorts, and prognostic performance of post-PCI QFR was compared in 2 cohorts. The primary outcome was 2-year vessel-oriented composite endpoint (VOCE), defined as composite of vessel-related cardiac death, vessel-related non-procedural myocardial infarction, and ischemia-driven target vessel revascularization.
Of 2,989 treated vessels, 2,227 (74.5%) with available post-PCI QFR were included, while 548 were presence of DM and 1,679 were not. The performance of post-PCI QFR to predict 2-year VOCE were moderate in both DM (area under the curve [AUC] 0.77, 95% confidence interval [CI]: 0.68 to 0.87) and non-DM cohorts (AUC 0.74, 95% CI: 0.67 to 0.82), while between-cohorts AUC difference was not significant (ΔAUC 0.03, P = 0.65). After multivariate adjustment, vessels with suboptimal post-PCI QFR results (≤0.92) were associated with higher risk of 2-year VOCE in both DM (adjusted HR 6.24, 95% CI: 2.40 to 16.2) and non-DM cohorts (adjusted HR 5.92, 95% CI: 3.28 to 10.7) without significant interaction (P for interaction 0.91).
This study, the first to directly compare clinical value of post-PCI QFR assessments in patients with and without DM, showed that a higher post-PCI QFR value was associated with improved long-term prognosis regardless of the presence of DM. Clinical Trial Registration Information URL: https://www.
gov; Unique identifier: NCT02017275.
比较在所有患者、多中心、随机对照 PANDA III 试验中接受经皮冠状动脉介入治疗（PCI）后的定量血流比（QFR）评估在合并和不合并糖尿病患者中的预后意义。
回顾性评估 PANDA III 试验中所有经治疗的血管的 PCI 后 QFR。将具有可用 PCI 后 QFR 的血管进一步分为 DM 和非 DM 队列，并比较 2 个队列中 PCI 后 QFR 的预后性能。主要终点是 2 年血管导向复合终点（VOCE），定义为与血管相关的心脏死亡、与血管相关的非致程序心肌梗死和缺血驱动的靶血管血运重建的复合终点。
在 2989 个治疗血管中，有 2227 个（74.5%）具有可用的 PCI 后 QFR，其中 548 个存在 DM，1679 个不存在 DM。在 DM 组（曲线下面积 [AUC] 0.77，95%置信区间 [CI]：0.68 至 0.87）和非 DM 组（AUC 0.74，95%CI：0.67 至 0.82）中，PCI 后 QFR 预测 2 年 VOCE 的性能均为中等，而两组间 AUC 差异无统计学意义（Δ AUC 0.03，P=0.65）。在多变量调整后，PCI 后 QFR 结果不理想（≤0.92）的血管与 2 年 VOCE 的风险增加相关，在 DM 组（调整后的 HR 6.24，95%CI：2.40 至 16.2）和非 DM 组（调整后的 HR 5.92，95%CI：3.28 至 10.7）中均如此，且交互作用无统计学意义（P 交互作用=0.91）。
这项研究首次直接比较了合并和不合并糖尿病患者 PCI 后 QFR 评估的临床价值，结果表明，较高的 PCI 后 QFR 值与长期预后改善相关，无论是否存在糖尿病。
临床试验注册信息 URL：https://www.clinicaltrials.gov；独特标识符：NCT02017275。
