Chen Lihua, Zhong Jiaxin, Hong Ruijin, Chen Yuxiang, Li Beilei, Wang Laicheng, Yan Yuanming, Chen Lianglong, Chen Qin, Luo Yukun
Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
Front Cardiovasc Med. 2024 Apr 17;11:1297218. doi: 10.3389/fcvm.2024.1297218. eCollection 2024.
To investigate the prognostic value of the consistency between the residual quantitative flow ratio (QFR) and postpercutaneous coronary intervention (PCI) QFR in patients undergoing revascularization.
This was a single-center, retrospective, observational study. All enrolled patients were divided into five groups according to the ΔQFR (defined as the value of the post-PCI QFR minus the residual QFR): (1) Overanticipated group; (2) Slightly overanticipated group; (3) Consistent group; (4) Slightly underanticipated group; and (5) Underanticipated group. The primary outcome was the 5-year target vessel failure (TVF).
A total of 1373 patients were included in the final analysis. The pre-PCI QFR and post-PCI QFR were significantly different among the five groups. TVF within 5 years occurred in 189 patients in all the groups. The incidence of TVF was significantly greater in the underanticipated group than in the consistent group ( = 0.008), whereas no significant differences were found when comparing the underanticipated group with the other three groups. Restricted cubic spline regression analysis showed that the risk of TVF was nonlinearly related to the ΔQFR. A multivariate Cox regression model revealed that a ΔQFR≤ -0.1 was an independent risk factor for TVF.
The consistency between the residual QFR and post-PCI QFR may be associated with the long-term prognosis of patients. Patients whose post-PCI QFR is significantly lower than the residual QFR may be at greater risk of TVF. An aggressive PCI strategy for lesions is anticipated to have less functional benefit and may not result in a better clinical outcome.
探讨血运重建患者残余定量血流比值（QFR）与经皮冠状动脉介入治疗（PCI）后QFR一致性的预后价值。
这是一项单中心、回顾性、观察性研究。所有纳入患者根据ΔQFR（定义为PCI后QFR值减去残余QFR值）分为五组：（1）过度预期组；（2）轻度过度预期组；（3）一致组；（4）轻度预期不足组；（5）预期不足组。主要结局为5年靶血管失败（TVF）。
最终分析共纳入1373例患者。五组患者PCI前QFR与PCI后QFR差异有统计学意义。所有组中189例患者发生5年内TVF。预期不足组TVF发生率显著高于一致组（=0.008），而预期不足组与其他三组比较无显著差异。限制立方样条回归分析显示TVF风险与ΔQFR呈非线性相关。多因素Cox回归模型显示ΔQFR≤ -0.1是TVF的独立危险因素。
残余QFR与PCI后QFR的一致性可能与患者长期预后相关。PCI后QFR显著低于残余QFR的患者TVF风险可能更高。对于病变采取积极的PCI策略预期功能获益较少，可能不会带来更好的临床结局。
