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Clinical Outcomes of Surgical Revascularization Strategies Guided by Quantitative Flow Ratio in Primary Noncoronary

Linlin Li1, Heng Zhang, Chenfei Rao

  • 1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.

Journal of Thoracic Imaging
|April 30, 2024
PubMed

Insights

Quantitative flow ratio (QFR) guidance in coronary artery bypass grafting (CABG) reduces long-term adverse cardiovascular events. This study found QFR-guided surgery led to better outcomes compared to standard angiography guidance.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Limited data exists on the application of quantitative flow ratio (QFR) in coronary artery bypass grafting (CABG).
  • Comparing QFR-guided versus coronary angiography-guided revascularization is crucial for optimizing surgical outcomes.
  • Understanding long-term adverse cardiovascular and cerebrovascular events is essential for patient management post-CABG.

Purpose of the Study:

  • To compare the incidence of long-term adverse cardiovascular and cerebrovascular events after QFR-guided versus coronary angiography-guided adult cardiac surgery with concurrent bypass surgery.
  • To evaluate the impact of QFR on surgical efficiency, including cardiopulmonary bypass (CPB) and aortic cross-clamping times.
  • To assess the safety and efficacy of QFR in guiding revascularization strategies during CABG.

Main Methods:

  • A retrospective analysis of 432 adult patients undergoing cardiopulmonary bypass (CPB) with coronary artery lesions (30-90% stenosis) between January 2015 and January 2016.
  • Patients were divided into two groups: Group A (optimal revascularization strategy guided by QFR) and Group B (coronary angiography-guided revascularization).
  • QFR was calculated for each patient, and outcomes including CPB duration, aortic cross-clamping time, perioperative mortality, major complications, and long-term major adverse cardiovascular and cerebrovascular events (MACCEs) were compared.

Main Results:

  • While the average number of distal anastomoses was similar between groups (1.9±1.0 vs. 1.7±0.9, P=0.081), Group A (QFR-guided) demonstrated significantly shorter CPB duration (114.4±49.2 vs. 135.8±55.2 minutes, P<0.001) and aortic cross-clamping time (83.6±36.2 vs. 101.1±40.6 minutes, P<0.001).
  • Perioperative mortality and major complication rates were comparable between the groups.
  • Long-term MACCEs were significantly lower in Group A (14.7%) compared to Group B (29.5%, P<0.001).

Conclusions:

  • In primary noncoronary cardiac surgery with concurrent CABG, an optimal revascularization strategy guided by QFR resulted in shorter CPB and aortic cross-clamping times compared to standard angiography guidance.
  • Multivariate analyses confirmed a reduced incidence of long-term MACCEs in the QFR-guided group.
  • QFR guidance appears to be a valuable tool for improving surgical efficiency and long-term patient outcomes in CABG procedures.
Abstract

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