Department of Internal Medicine, Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea.
Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain.
Catheter Cardiovasc Interv. 2022 Dec;100(7):1208-1217. doi: 10.1002/ccd.30451. Epub 2022 Nov 2.
The clinical value of residual quantitative flow ratio (rQFR), a novel function of QFR technique, is unknown.
We investigated the clinical value of rQFR, aimed to predict residual ischemia after virtual percutaneous coronary intervention (vPCI).
This is a substudy of the COE-PERSPECTIVE registry, which investigated the prognostic value of post-PCI fractional flow reserve (FFR). From pre-PCI angiograms, QFR and rQFR were analyzed and their diagnostic performance was assessed at blinded fashion using pre-PCI FFR and post-PCI FFR as reference, respectively. The prognostic value of rQFR after vPCI was assessed according to vessel-oriented composite outcome (VOCO) at 2 years.
We analyzed 274 patients (274 vessels) with FFR-based ischemic causing lesions (49%) from 555 screened patients. Pre-PCI QFR and FFR were 0.63 ± 0.10 and 0.66 ± 0.11 (R = 0.756, p < 0.001). rQFR after vPCI and FFR after real PCI were 0.93 ± 0.06 and 0.86 ± 0.07 (R = 0.528, p < 0.001). The mean difference between rQFR and post-PCI FFR was 0.068 (95% limit of agreement: -0.05 to 0.19). Diagnostic performance of rQFR to predict residual ischemia after PCI was good (area under the curve [AUC]: 0.856 [0.804-0.909], p < 0.001). rQFR predicted well the incidence of 2-year VOCO after index PCI (AUC: 0.712 [0.555-0.869], p = 0.041), being similar to that of actual post-PCI FFR (AUC: 0.691 [0.512-0.870], p = 0.061). rQFR ≤0.89 was associated with increased risk of 2-year VOCO (hazard ratio [HR]: 12.9 [2.32-71.3], p = 0.0035). This difference was mainly driven by a higher rate of target vessel revascularization (HR: 16.98 [2.33-123.29], p = 0.0051).
rQFR estimated from pre-PCI angiography and virtual coronary stenting mildly overestimated functional benefit of PCI. However, it well predicted suboptimal functional result and long-term vessel-related clinical events.
Influence of fractional flow reserve on the Clinical OutcomEs of PERcutaneouS Coronary Intervention (COE-PESPECTIVE) Registry, NCT01873560.
定量血流分数比（QFR）技术的一项新功能残余定量血流分数比（rQFR）的临床价值尚不清楚。
我们旨在研究 rQFR 的临床价值，以预测虚拟经皮冠状动脉介入治疗（vPCI）后的残余缺血。
这是 COE-PERSPECTIVE 注册研究的一项子研究，该研究调查了 PCI 后血流储备分数（FFR）的预后价值。从术前血管造影中，分别以术前 FFR 和术后 FFR 为参考，对 QFR 和 rQFR 进行分析，并以盲法评估其诊断性能。根据 2 年时的血管定向复合结局（VOCO）评估 vPCI 后 rQFR 的预后价值。
我们分析了来自 555 例筛选患者中 274 例（274 支血管）存在基于 FFR 的缺血性病变患者。术前 QFR 和 FFR 分别为 0.63±0.10 和 0.66±0.11（R=0.756，p<0.001）。vPCI 后 rQFR 和实际 PCI 后 FFR 分别为 0.93±0.06 和 0.86±0.07（R=0.528，p<0.001）。rQFR 与术后 FFR 之间的平均差值为 0.068（95%一致性区间：-0.05 至 0.19）。rQFR 预测 PCI 后残余缺血的诊断性能良好（曲线下面积[AUC]：0.856[0.804-0.909]，p<0.001）。rQFR 很好地预测了指数 PCI 后 2 年 VOCO 的发生率（AUC：0.712[0.555-0.869]，p=0.041），与实际术后 FFR（AUC：0.691[0.512-0.870]，p=0.061）相似。rQFR≤0.89 与 2 年 VOCO 的发生风险增加相关（风险比[HR]：12.9[2.32-71.3]，p=0.0035）。这种差异主要是由靶血管血运重建率较高引起的（HR：16.98[2.33-123.29]，p=0.0051）。
基于术前血管造影和虚拟冠状动脉支架术估计的 rQFR 略微高估了 PCI 的功能获益。然而，它很好地预测了不理想的功能结果和长期的血管相关临床事件。
血流储备分数对经皮冠状动脉介入治疗临床结果的影响（COE-PESPECTIVE）注册研究，NCT01873560。
