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Published on: November 24, 2014
Prognostic value of quantitative flow ratio measured immediately after percutaneous coronary intervention for chronic
Zheng Qiao1,2, Zhang-Yu Lin1,2, Qian-Qian Liu2
1State Key Laboratory of Cardiovascular Disease, Beijing, China.
Insights
Quantitative flow ratio (QFR) after percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) predicts patient outcomes. Achieving a post-PCI QFR of 0.91 or higher is associated with significantly better 2-year prognosis.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- The clinical significance of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients undergoing PCI for chronic total occlusion (CTO) remains unclear.
- Assessing functional outcomes after CTO PCI is crucial for patient management.
Purpose of the Study:
- To evaluate the impact of post-PCI QFR on 2-year vessel-oriented composite endpoints (VOCEs) in patients with CTO.
- To determine the optimal QFR cutoff value for predicting adverse events after CTO PCI.
Main Methods:
- Retrospective analysis of CTO vessels from the PANDA III trial with successful anatomical PCI.
- Post-PCI QFR was measured, and the primary outcome was 2-year VOCEs (cardiac death, MI, or revascularization).
- Receiver operator characteristic curve analysis identified the optimal QFR cutoff; Cox models assessed hazard ratios.
Main Results:
- Of 428 CTO vessels, 353 (82.5%) had analyzable post-PCI QFR. 31 VOCEs (8.7%) occurred at 2 years.
- The optimal post-PCI QFR cutoff for predicting 2-year VOCEs was 0.91.
- Vessels with post-PCI QFR < 0.91 (n=91) had a significantly higher incidence of VOCEs (22.0%) compared to those with QFR ≥ 0.91 (n=262) (4.2%), with a hazard ratio of 4.98.
Conclusions:
- Higher post-PCI QFR values correlate with improved prognosis in coronary CTO interventions.
- Achieving a functionally optimal PCI result, defined as a post-PCI QFR ≥ 0.91, is associated with better long-term outcomes for patients with CTO lesions.
Background:
The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.
Methods:
All CTO vessels treated with successful anatomical PCI in patients from PANDA III trial were retrospectively measured for post-PCI QFR. The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs, composite of target vessel-related cardiac death, target vessel-related myocardial infarction, and ischemia-driven target vessel revascularization). Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs, and all vessels were stratified by this optimal cutoff value. Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.
Results:
Among 428 CTO vessels treated with PCI, 353 vessels (82.5%) were analyzable for post-PCI QFR. 31 VOCEs (8.7%) occurred at 2 years. Mean value of post-PCI QFR was 0.92 ± 0.13. Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91. The incidence of 2-year VOCEs in the vessel with post-PCI QFR < 0.91 (n = 91) was significantly higher compared with the vessels with post-PCI QFR ≥ 0.91 (n = 262) (22.0% vs. 4.2%, HR = 4.98, 95% CI: 2.32-10.70).
Conclusions:
Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO. Achieving functionally optimal PCI results (post-PCI QFR value ≥ 0.91) tends to get better prognosis for patients with CTO lesions.
