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Deceleration Capacity Improves Prognostic Accuracy of Relative Increase and Final Coronary Physiology in Patients
Jun Wang1,2,3,4, Chengzhe Liu1,2,3,4, Fuding Guo1,2,3,4
1Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.
Insights
Deceleration capacity (DC) combined with quantitative flow ratio (QFR) improves risk prediction for non-ST-elevation acute coronary syndrome (NSTE-ACS) patients after percutaneous coronary intervention (PCI). This approach enhances existing clinical models for major adverse cardiac and cerebrovascular events (MACCEs).
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Physiology
Background:
- Both coronary physiology and deceleration capacity (DC) have demonstrated prognostic value in acute coronary syndrome (ACS).
- Quantitative flow ratio (QFR) assesses coronary physiology, while DC reflects autonomic nervous system function.
- Non-ST-elevation ACS (NSTE-ACS) is a common presentation requiring risk stratification.
Purpose of the Study:
- To evaluate the prognostic implication of combining DC with QFR-derived coronary physiology in NSTE-ACS patients.
- To determine if this combined approach improves risk prediction for major adverse cardiac and cerebrovascular events (MACCEs) post-percutaneous coronary intervention (PCI).
- To assess the predictive efficacy of relative QFR increase and final QFR alongside DC.
Main Methods:
- Retrospective cohort study including NSTE-ACS patients who underwent successful PCI with pre- and post-procedural QFR.
- 24-hour DC (DC 24h) data obtained via Holter monitoring.
- Multivariate Cox regression and ROC analysis used to determine optimal cutoffs and predictive efficacy for MACCEs.
Main Results:
- Higher post-PCI QFR, higher relative QFR increase, and higher DC were independent predictors of lower MACCE risk.
- Incorporating low DC (≤2.42) significantly improved the predictive efficacy of low relative QFR increase (≤23%) and low post-PCI QFR (≤0.88) for MACCEs.
- 31 out of 240 patients experienced MACCEs during a mean follow-up of 21.3 months.
Conclusions:
- Combining DC with QFR-derived coronary physiology (relative increase and final) enhances MACCE risk prediction in NSTE-ACS patients post-PCI.
- This integrated approach offers improved prognostic capability compared to models based solely on clinical variables.
- The findings suggest a potential role for DC and QFR in refining risk stratification strategies for NSTE-ACS.
Background:
Both coronary physiology and deceleration capacity (DC) showed prognostic efficacy for patients with acute coronary syndrome (ACS). This retrospective cohort study was performed to evaluate the prognostic implication of DC combined with the relative increase and final coronary physiology as detected by quantitative flow ratio (QFR) for patients with non-ST-elevation ACS (NSTE-ACS) who underwent complete and successful percutaneous coronary intervention (PCI).
Methods:
Patients with NSTE-ACS who underwent PCI with pre- and post-procedural QFR in our department between January 2018 and November 2019 were included. The 24-hour deceleration capacity (DC 24h) was obtained via Holter monitoring. The incidence of major adverse cardiac and cerebrovascular events (MACCEs) during follow up was defined as the primary outcome. The optimal cutoffs of the relative increase, final QFR, and DC 24h for prediction of MACCEs were determined via receiver operating characteristic (ROC) analysis and the predictive efficacies were evaluated with multivariate Cox regression analysis.
Results:
Overall, 240 patients were included. During a mean follow up of 21.3 months, 31 patients had MACCEs. Results of multivariate Cox regression analyses showed that a higher post-PCI QFR [adjusted hazard ratio (HR): 0.318; 95% confidence interval (CI): 0.129-0.780], a higher relative QFR increase (HR: 0.161; 95% CI: 0.066-0.391], and a higher DC (HR: 0.306; 95% CI: 0.134-0.701) were all independent predictors of lower risk of MACCEs. Subsequently, incorporating low DC (≤2.42) into the risk predicting model with clinical variables, the predictive efficacies of low relative QRS increase (≤23%) and low post-PCI QFR (≤0.88) for MACCEs were both significantly improved.
Conclusions:
The DC combined with relative increase and final coronary physiology may improve the predictive efficacy of existing models based on clinical variables for MACCEs in NSTE-ACS patients who underwent complete and successful PCI.
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