Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
J Cardiol. 2022 Dec;80(6):511-517. doi: 10.1016/j.jjcc.2022.07.007. Epub 2022 Jul 29.
The optimal endpoint after balloon angioplasty remains poorly defined. This study aimed to characterize post-balloon angioplasty anatomical and physiological indexes by quantitative flow ratio (QFR) and to compare their prognostic impacts on long-term clinical outcomes.
This retrospective study included 106 lesions from 106 patients who underwent percutaneous coronary interventions with drug-coated-balloon (n = 69) or plain-old-balloon-angioplasty (n = 37). Analyses measured minimum lumen diameter (MLD) and percent diameter stenosis (%DS) as anatomical indexes; QFR of target vessel (QFR-vessel) and QFR-gradient (ΔQFR between proximal and distal segments of the lesion) as physiological indexes. Primary endpoint was target lesion revascularization (TLR) after the index procedure.
TLR occurred in 21 (20 %) lesions. TLR group showed significantly smaller QFR-vessel (0.79 ± 0.12 vs. 0.85 ± 0.12, p = 0.03), as well as greater QFR-gradient (0.12 ± 0.07 vs. 0.04 ± 0.03, p < 0.0001) at post-procedure compared with non-TLR group. The percentage of angiographically significant dissection was also more frequently observed in TLR group compared with non-TLR group (47.6 % vs. 14.1 %, p < 0.0001 for log-rank). In the multivariate analysis, angiographically significant dissection and QFR-gradient at post-procedure was significantly associated with TLR. In the receiver-operating characteristics curve analysis, the area under the curve for predicting post-procedural TLR was significantly greater for QFR-gradient than for MLD and residual %DS (p < 0.0001 for MLD and p = 0.0003 for residual %DS at post-procedure). The best cut-off value of post-procedural QFR-gradient for predicting TLR was 0.08.
Post-procedural QFR-gradient across the lesion was a statistically independent and stronger predictor of TLR, compared with anatomical indexes.
球囊血管成形术后的最佳终点仍未得到很好的定义。本研究旨在通过定量血流比（QFR）来描述球囊血管成形术后的解剖学和生理学指标，并比较它们对长期临床结局的预后影响。
本回顾性研究纳入了 106 名接受药物涂层球囊（n=69）或普通球囊血管成形术（n=37）经皮冠状动脉介入治疗的患者的 106 处病变。分析测量了最小管腔直径（MLD）和直径狭窄率（%DS）作为解剖学指标；目标血管的 QFR（QFR-血管）和 QFR-梯度（病变近端和远端之间的 QFR 差值）作为生理学指标。主要终点是索引程序后的靶病变血运重建（TLR）。
21 处（20%）病变发生 TLR。TLR 组术后 QFR-血管显著较小（0.79±0.12 vs. 0.85±0.12，p=0.03），且 QFR-梯度较大（0.12±0.07 vs. 0.04±0.03，p<0.0001）。与非 TLR 组相比。TLR 组也更频繁地观察到血管造影显著夹层（47.6% vs. 14.1%，log-rank，p<0.0001）。多变量分析显示，术后血管造影显著夹层和 QFR-梯度与 TLR 显著相关。在受试者工作特征曲线分析中，预测术后 TLR 的 QFR-梯度的曲线下面积明显大于 MLD 和残余%DS（MLD 时 p<0.0001，术后 p=0.0003）。预测 TLR 的术后 QFR-梯度最佳截断值为 0.08。
与解剖学指标相比，病变处的术后 QFR-梯度是 TLR 的一个统计学上独立且更强的预测因子。
