Hospital Clínico Universitario de Valladolid, Valladolid, CIBERCV, Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain.
Hospital Universitario Miguel Servet, Zaragoza, Spain.
Int J Cardiol. 2023 Oct 15;389:131176. doi: 10.1016/j.ijcard.2023.131176. Epub 2023 Jul 11.
Confirming the prognostic value of global QFR and evaluating the long-term prognosis of QFR-concordant therapy in stable coronary artery disease.
Wire-based functional evaluation of coronary disease is linked to patient's prognosis. Quantitative Flow Ratio (QFR) is a newer index of computational physiology, linked to clinical outcomes and prognosis at 1 year follow-up. Long-term prognosis of QFR-concordant revascularization in stable coronary artery disease is however unknown hitherto.
Consecutive patients with stable coronary disease undergoing coronary angiography were included. Centralized and blinded QFR analysis of three coronary territories was performed. Three vessel QFR (3vQFR) was defined as the sum of the basal QFR of each coronary territory. QFR-concordant revascularization was met if all significant lesions (QFR ≤ 0.80) were revascularized and all non-significant lesions (QFR > 0.80) were not; otherwise, the case was defined as QFR-discordant revascularization. Patient-oriented composite end-point (POCE) of cardiac death, myocardial infarction and unscheduled revascularization was the primary endpoint.
A total of 803 patients from six high-volume centers were included. Canadian Cardiovascular Society (CCS) class II angina was the most frequent (48.9%) clinical presentation. Median of follow-up was 68.8 months. 3vQFR was an independent predictor of POCE (HR 1.79 CI95% 1.01-3.18), with 2.75 as optimal cut-off value, irrespective of the therapy received. QFR-discordant revascularization (QFR+/Revascularization- or QFR-/Revascularization+) was an independent predictor of POCE in multivariate analysis (HR 1.65, CI 95% 1.03-2.64).
Global burden of epicardial coronary atherosclerosis, as evaluated by 3vQFR, as well as QFR-discordant therapy are independent predictors of adverse clinical outcome at long-term follow-up in stable coronary artery disease.
验证全球 QFR 的预后价值，并评估稳定型冠状动脉疾病中 QFR 一致治疗的长期预后。
基于导丝的冠状动脉疾病功能评估与患者的预后相关。定量血流比（QFR）是一种新的计算生理学指标，与 1 年随访时的临床结果和预后相关。然而，迄今为止，稳定型冠状动脉疾病中 QFR 一致血运重建的长期预后尚不清楚。
纳入接受冠状动脉造影的连续稳定型冠状动脉疾病患者。对三个冠状动脉区域进行集中和盲法 QFR 分析。三血管 QFR（3vQFR）定义为每个冠状动脉区域的基础 QFR 之和。如果所有显著病变（QFR≤0.80）均进行血运重建且所有非显著病变（QFR＞0.80）未进行血运重建，则定义为 QFR 一致血运重建；否则，定义为 QFR 不一致血运重建。以心脏死亡、心肌梗死和非计划性血运重建的患者为中心的复合终点（POCE）为主要终点。
来自六个高容量中心的共 803 例患者纳入研究。加拿大心血管学会（CCS）Ⅱ级心绞痛是最常见的临床表现（48.9%）。中位随访时间为 68.8 个月。3vQFR 是 POCE 的独立预测因子（HR 1.79，95%CI 1.01-3.18），2.75 为最佳截断值，与所接受的治疗无关。多变量分析显示，QFR 不一致血运重建（QFR+/血运重建-或 QFR-/血运重建+）是 POCE 的独立预测因子（HR 1.65，95%CI 1.03-2.64）。
3vQFR 评估的冠状动脉心外膜粥样硬化总负荷以及 QFR 不一致治疗是稳定型冠状动脉疾病长期随访中不良临床结局的独立预测因子。
