Tang Zhouhao, Hu Yumeng, Qin Jixing, Jin Ge, Chen Xianda, Wang Chao, Xiang Jianping, Guan Xueqiang
Department of Cardiology, Key Laboratory of Panvascular Diseases of Wenzhou, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
ArteryFlow Technology Co., Ltd., Hangzhou, China.
Quant Imaging Med Surg. 2025 Jun 6;15(6):5739-5751. doi: 10.21037/qims-24-2238. Epub 2025 May 30.
Angiography-derived fractional flow reserve (AccuFFRangio) has emerged as a reliable tool for coronary functional assessment, demonstrating high concordance with invasive fractional flow reserve (FFR). This study aimed to determine the previously uninvestigated predictive value of combining AccuFFRangio with translesion gradient (TLG) following drug-coated balloon (DCB) angioplasty.
This retrospective study included 232 patients treated with DCB angioplasty. Post-DCB AccuFFRangio and TLG were successfully measured in 218 patients. The vessels were classified according to dichotomous post-DCB AccuFFRangio and TLG. The primary endpoint was 2-year risk of target vessel failure (TVF), which is a composite of target vessel revascularization, target vessel myocardial infarction (MI), and cardiac death.
The optimal cutoff for post-DCB AccuFFRangio was 0.89. A post-DCB AccuFFRangio ≤0.89 was strongly associated with higher rates of TVF (14.3% 2.8%; P=0.002), and a TLG of >0.03 was associated with increased rates of TVF (13.5% 4.9%; P=0.046). Key predictors of adverse outcomes included male gender, smoking status, higher residual diameter stenosis, and post-DCB AccuFFRangio and TLG. In multivariate analysis, AccuFFRangio was independently predictive of TVF. The patient subgroup with high TLG and low AccuFFRangio had significantly higher rates of TVF (15.2%) as compared to the other groups (P=0.005).
Immediate post-DCB AccuFFRangio and TLG can be effectively used for stratifying risk and predicting long-term outcomes in patients undergoing DCB angioplasty. Post-DCB AccuFFRangio, in particular, offers significant prognostic insights beyond traditional clinical and imaging parameters, suggesting its potential as a critical tool in postangioplasty patient management.
血管造影衍生的血流储备分数（AccuFFRangio）已成为冠状动脉功能评估的可靠工具，与有创血流储备分数（FFR）高度一致。本研究旨在确定药物涂层球囊（DCB）血管成形术后将AccuFFRangio与跨病变梯度（TLG）相结合的预测价值，此前该价值尚未得到研究。
这项回顾性研究纳入了232例行DCB血管成形术的患者。218例患者成功测量了DCB术后的AccuFFRangio和TLG。根据DCB术后二分法的AccuFFRangio和TLG对血管进行分类。主要终点是2年靶血管失败（TVF）风险，TVF是靶血管血运重建、靶血管心肌梗死（MI）和心源性死亡的复合终点。
DCB术后AccuFFRangio的最佳截断值为0.89。DCB术后AccuFFRangio≤0.89与较高的TVF发生率密切相关（14.3%对2.8%；P = 0.002），TLG>0.03与TVF发生率增加相关（13.5%对4.9%；P = 0.046）。不良结局的关键预测因素包括男性、吸烟状况、较高的残余直径狭窄以及DCB术后的AccuFFRangio和TLG。在多变量分析中，AccuFFRangio可独立预测TVF。与其他组相比，TLG高且AccuFFRangio低的患者亚组TVF发生率显著更高（15.2%）（P = 0.005）。
DCB术后即刻的AccuFFRangio和TLG可有效用于对接受DCB血管成形术的患者进行风险分层和预测长期结局。特别是DCB术后AccuFFRangio，除了传统的临床和影像学参数外，还能提供重要的预后见解，表明其作为血管成形术后患者管理关键工具的潜力。
