Department of Cardiology, Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Xinquan, Road 29#, Fuzhou, 350001, Fujian, China.
Sci Rep. 2023 Mar 16;13(1):4391. doi: 10.1038/s41598-023-30991-4.
We aimed to evaluate the impact of new Murray law-based QFR of jailed left circumflex coronary artery (LCx) on long-term clinical outcomes after left main coronary artery (LM) simple crossover stenting. 164 patients who underwent LM-to-left anterior descending coronary artery simple crossover stenting and had appropriate angiographic view of LCx for QFR computation were enrolled. The primary clinical outcome was the 5-year target lesion failure (TLF), defined as a composite of cardiac death, a target vessel myocardial infarction or target lesion repeat revascularization. The mean QFR of the LCx after LM stent implantation was 0.88 ± 0.09, and 29 patients (17.7%) had a low QFR (< 0.80), which was significantly associated with a higher 5-year rate of TLF when compared with the high QFR group (27.6% vs. 6.7%; HR: 4.235; 95% CI 1.21-14.95; p = 0.0015). The 5-year LCx ostium-related TLR rate in the low QFR group was also higher (17.2% vs. 3.0% in the high QFR group; HR: 6.07, 95% CI 1.63-22.59, p = 0.002). In a multivariate Cox regression analysis, a low QFR in the LCx after LM stenting was an independent predictor of the 5-year TLF rate (HR: 3.21, 95% CI 1.21-8.53; p = 0.019). ROC analysis showed that QFR a negative predictive value (NPV) of 89.6% ([AUC] 0.73, 95% CI 0.58-0.88, p < 0.05), the cutoff point is 0.85. The patients with a low QFR (< 0.80) in jailed LCX after LM simple crossover stenting had worse 5-year outcomes than those with a high QFR. Conversely, a QFR ≥ 0.85 of jailed LCx could serve as a good predictor of low risk of adverse outcome in LCx ostium. The QFR computation of the jailed LCx may be helpful to determine whether an additional procedure is required for the jailed side branch.
我们旨在评估新的基于 Murray 法则的 QFR 对左主干冠状动脉（LM）单纯交叉支架置入后左回旋支（LCx）长期临床结局的影响。共纳入 164 例接受 LM 至左前降支（LAD）单纯交叉支架置入术且 LCx 有合适的 QFR 计算血管造影视图的患者。主要临床终点为 5 年靶病变失败（TLF），定义为心脏死亡、靶血管心肌梗死或靶病变再次血运重建的复合终点。LM 支架置入后 LCx 的平均 QFR 为 0.88 ± 0.09，29 例（17.7%）QFR 较低（<0.80），与 QFR 较高组相比，5 年 TLF 发生率更高（27.6%比 6.7%；HR：4.235；95%CI 1.21-14.95；p=0.0015）。低 QFR 组 5 年 LCx 开口相关 TLR 发生率也较高（17.2%比 QFR 较高组 3.0%；HR：6.07，95%CI 1.63-22.59，p=0.002）。多变量 Cox 回归分析显示，LM 支架置入后 LCx 的低 QFR 是 5 年 TLF 发生率的独立预测因素（HR：3.21，95%CI 1.21-8.53；p=0.019）。ROC 分析显示，QFR 的阴性预测值（NPV）为 89.6%[AUC 0.73，95%CI 0.58-0.88，p<0.05]，截断点为 0.85。LM 单纯交叉支架置入后 LCx 中 QFR 较低（<0.80）的患者 5 年结局较 QFR 较高的患者差。相反，LCx 中 QFR≥0.85可作为 LCx 开口不良结局低风险的良好预测因子。LCx 受困分支 QFR 的计算可能有助于确定是否需要对受困分支进行额外的介入治疗。
