Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.
J Thorac Cardiovasc Surg. 2024 Jul;168(1):121-132.e10. doi: 10.1016/j.jtcvs.2023.04.011. Epub 2023 Apr 20.
Quantitative flow ratio (QFR) is a novel noninvasive tool for the functional assessment of coronary stenosis. Whether or not QFR could predict graft outcomes after coronary artery bypass grafting procedure is unknown. This study aimed to investigate the association of QFR value with graft outcomes after coronary artery bypass grafting surgery.
The QFR values were retrospectively obtained from patients receiving coronary artery bypass grafting surgery from 2017 to 2019 in the Graft Patency Between No-Touch Vein Harvesting Technique and Conventional Approach in Coronary Artery Bypass Graft Surgery (PATENCY) trial. QFR calculation was conducted in eligible coronary arteries, defined as those with ≥50% stenosis and a diameter ≥1.5 mm. A threshold of QFR ≤0.80 was considered functionally significant stenosis. The primary outcome was graft occlusion at 12 months evaluated by computed tomography angiography.
Two thousand twenty-four patients with 7432 grafts (2307 arterial grafts and 5125 vein grafts) were included. For the arterial grafts, the risk of 12-month occlusion was significantly increased in the QFR >0.80 group than in the QFR ≤0.80 group (7.1% vs 2.6%; P = .001; unadjusted model: odds ratio, 3.08; 95% CI, 1.65-5.75; fully adjusted model: odds ratio, 2.67; 95% CI, 1.44-4.97). No significant association was observed in the vein grafts (4.6% vs 4.3%; P = .67; unadjusted model: odds ratio, 1.10; 95% CI, 0.82-1.47; fully adjusted model: odds ratio, 1.12; 95% CI, 0.83-1.51). Results were stable across sensitivity analyses with a QFR threshold of 0.78 and 0.75.
Target vessel QFR >0.80 was associated with a significantly higher risk of arterial graft occlusion at 12 months after coronary artery bypass grafting surgery. No significant association was found between target lesion QFR and vein graft occlusion.
定量血流比值（QFR）是一种用于评估冠状动脉狭窄功能的新型无创工具。QFR 是否可以预测冠状动脉旁路移植术后的桥接血管结局尚不清楚。本研究旨在探讨 QFR 值与冠状动脉旁路移植术后桥接血管结局之间的关系。
回顾性获取 2017 年至 2019 年在冠状动脉旁路移植术中无接触静脉采集技术与传统方法比较（PATENCY）试验中接受冠状动脉旁路移植术的患者的 QFR 值。在狭窄程度≥50%且直径≥1.5mm 的有意义冠状动脉中进行 QFR 计算。QFR≤0.80 被认为存在功能显著狭窄。主要结局是通过计算机断层血管造影术评估 12 个月时的桥接血管闭塞。
共纳入 2024 例患者，7432 个桥接血管（2307 个动脉桥接血管和 5125 个静脉桥接血管）。对于动脉桥接血管，QFR>0.80 组的 12 个月闭塞风险明显高于 QFR≤0.80 组（7.1%比 2.6%；P=0.001；未调整模型：优势比，3.08；95%CI，1.65-5.75；完全调整模型：优势比，2.67；95%CI，1.44-4.97）。静脉桥接血管未见明显相关性（4.6%比 4.3%；P=0.67；未调整模型：优势比，1.10；95%CI，0.82-1.47；完全调整模型：优势比，1.12；95%CI，0.83-1.51）。当 QFR 阈值为 0.78 和 0.75 时，敏感性分析结果稳定。
冠状动脉旁路移植术后 12 个月，靶血管 QFR>0.80 与动脉桥接血管闭塞的风险显著增加相关。目标病变 QFR 与静脉桥接血管闭塞之间无显著相关性。
Zotero 插件