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Coronary Angiography-Derived Murray Law-Based Quantitative Flow Ratio (μQFR) After De Novo Drug-Coated Balloon
Dorian Garin1, Diego Arroyo1, Juan F Iglesias2
1Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland.
Insights
Immediate post-procedure three-dimensional (3D) Murray-law quantitative flow ratio (μQFR) effectively predicts outcomes after drug-coated balloon (DCB) angioplasty for coronary artery disease. Lower μQFR values indicate a higher risk of adverse events.
Area of Science:
- Interventional Cardiology
- Cardiovascular Physiology
- Medical Imaging
Background:
- Drug-coated balloon (DCB) angioplasty is a stentless option for de novo coronary artery disease.
- The prognostic significance of post-procedural angiography-derived physiology, specifically 3D Murray-law quantitative flow ratio (μQFR), after DCB in native vessels is not well-established.
Purpose of the Study:
- To determine the prognostic value of immediate post-DCB 3D-μQFR in predicting lesion failure in de novo coronary disease.
- To assess the association between 3D-μQFR and vessel-oriented composite endpoints (VOCE).
Main Methods:
- Analysis of the prospective CARDIO-FR registry of patients undergoing DCB angioplasty for de novo coronary lesions.
- Offline performance of 3D-μQFR and quantitative coronary angiography by independent analysts.
- Evaluation of the vessel-oriented composite endpoint (VOCE) including cardiac death, target-vessel myocardial infarction, or target-vessel revascularization.
Main Results:
- Among 81 patients, 33 lesions experienced VOCE during a median 240-day follow-up.
- Post-procedural 3D-μQFR was significantly lower in VOCE lesions (76.5 vs. 90.0, p < 0.001).
- An optimal μQFR threshold of 0.83 was identified (AUC 0.74); μQFR < 0.83 independently predicted higher VOCE rates (HR 6.01, p < 0.0001).
Conclusions:
- Immediate post-DCB 3D-μQFR is an independent predictor of adverse vessel outcomes in de novo coronary disease.
- Physiology-guided optimization of DCB angioplasty may enhance long-term results.
- Prospective validation of these findings is warranted.
Background:
Drug-coated balloon (DCB) angioplasty has emerged as a stentless alternative for de novo coronary artery disease. However, the prognostic value of post-procedural angiography-derived physiology, particularly three-dimensional (3D) Murray-law quantitative flow ratio (μQFR), after DCB in native vessels remains unclear.
Objectives:
To quantify the prognostic value of immediate post-DCB 3D-μQFR for predicting lesion failure in de novo coronary disease.
Methods:
We conducted an analysis of the prospective CARDIO-FR registry, including all patients undergoing DCB angioplasty for de novo coronary lesions between January 2018 and December 2024. 3D-μQFR and quantitative coronary angiography were performed offline by independent analysts. The primary endpoint was the vessel-oriented composite endpoint (VOCE: cardiac death, target-vessel myocardial infarction, or target-vessel revascularization).
Results:
Among 81 patients (87 lesions), VOCE occurred in 33 lesions during median follow-up of 240 days. Post-procedural 3D-μQFR was significantly lower in VOCE lesions (median 76.5 vs. 90.0, p < 0.001). ROC analysis identified optimal μQFR threshold of 0.83 (AUC 0.74). In multivariate and propensity-matched analyses, μQFR < 0.83 was independently associated with higher VOCE rates (HR 6.01, 95% CI 2.48-14.46, p < 0.0001).
Conclusions:
Immediate post-DCB 3D-μQFR independently predicts adverse vessel outcomes in de novo coronary disease. Physiology-guided optimization of DCB angioplasty may improve long-term results and warrants prospective validation.
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