Zhu Yun-Hui, Hong Xu-Lin, Hu Tian-Li, Bian Qian-Qian, Chen Yu-Fei, Zhou Tian-Ping, Li Jing, Fu Guo-Sheng, Zhang Wen-Bin
Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
J Geriatr Cardiol. 2025 Mar 28;22(3):332-343. doi: 10.26599/1671-5411.2025.03.006.
Quantitative flow ratio (QFR) holds significant value in guiding drug-coated balloon (DCB) treatment and enhancing outcomes. However, the predictive capability of post-angioplasty QFR for long-term clinical events in patients with de novo lesions who receive DCB treatment remains uncertain. The aim of this study was to explore the potential significance of post-angioplasty QFR measurements in predicting clinical outcomes in patients underwent DCB treatment for de novo lesions.
Patients who underwent DCB-only intervention for de novo lesions were enrolled. QFR was conducted after DCB treatment. The patients were then categorized based on post-angioplasty QFR. The primary endpoint was major adverse cardiac events (MACE), encompassing all-cause death, cardiovascular death, nonfatal myocardial infarction, stroke, and target vessel revascularization.
A total of 553 patients with 561 lesions were included. The median follow-up period was 505 days, during which 66 (11.8%) MACEs occurred. Based on post-procedural QFR grouping, there were 259 cases in the high QFR group (QFR > 0.93) and 302 cases in the low QFR group (QFR ≤ 0.93). Kaplan-Meier analysis revealed a significantly higher cumulative incidence of MACE in the low QFR group (log-rank = 0.004). The multivariate Cox proportional hazards model demonstrated a significant inverse correlation between QFR and the occurrence of MACEs (HR = 0.522, 95%CI: 0.289-0.942, = 0.031). Landmark analysis indicated that high QFR had a significant reducing effect on the cumulative incidence of MACEs within 1 year (log-rank = 0.016) and 1-5 years (log-rank = 0.026).
In patients who underwent DCB-only treatment for de novo lesions, higher post-procedural QFR values (> 0.93) were identified as an independent protective factor against adverse prognosis.
定量血流比（QFR）在指导药物涂层球囊（DCB）治疗及改善治疗效果方面具有重要价值。然而，对于接受DCB治疗的初发病变患者，血管成形术后QFR对长期临床事件的预测能力仍不明确。本研究旨在探讨血管成形术后QFR测量值在预测接受DCB治疗的初发病变患者临床结局中的潜在意义。
纳入仅接受DCB治疗初发病变的患者。DCB治疗后进行QFR检测。然后根据血管成形术后QFR对患者进行分类。主要终点为主要不良心血管事件（MACE），包括全因死亡、心血管死亡、非致死性心肌梗死、中风及靶血管血运重建。
共纳入553例患者的561处病变。中位随访期为505天，期间发生66例（11.8%）MACE。根据术后QFR分组，高QFR组（QFR>0.93）有259例，低QFR组（QFR≤0.93）有302例。Kaplan-Meier分析显示，低QFR组MACE的累积发生率显著更高（对数秩检验P=0.004）。多因素Cox比例风险模型显示，QFR与MACE的发生呈显著负相关（风险比=0.522，95%置信区间：0.289-0.942，P=0.031）。地标分析表明，高QFR对1年内（对数秩检验P=0.016）和1-5年内（对数秩检验P=0.026）MACE的累积发生率有显著降低作用。
在仅接受DCB治疗初发病变的患者中，较高的术后QFR值（>0.93）被确定为不良预后的独立保护因素。
