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Physiological and metabolic predictors of adverse outcomes one year after coronary intervention: A two-tiered

Yuxiang Chen1, Jiaxin Zhong1, Beilei Li1

  • 1Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian 350001, PR China; Fujian Cardiovascular Medicine Center, Fuzhou, Fujian 350001, PR China; Fujian Institute of Coronary Artery Disease, Fuzhou, Fujian 350001, PR China; Fujian Cardiovascular Research Center, Fuzhou, Fujian 350001, PR China; Fujian Medical University Heart Center, Fuzhou, Fujian 350001, PR China.

Current Problems in Cardiology
|November 26, 2025
PubMed

Insights

Three-vessel quantitative flow ratio (3V-QFR) below 2.44 indicates poor prognosis after percutaneous coronary intervention (PCI). In patients with good flow, high triglyceride-glucose (TyG) index signals increased metabolic risk, improving secondary prevention strategies.

Area of Science:

  • Cardiology
  • Metabolic Syndrome
  • Interventional Cardiology

Background:

  • Residual ischemia and metabolic dysregulation impact long-term prognosis post-percutaneous coronary intervention (PCI).
  • Assessing prognostic markers like three-vessel quantitative flow ratio (3V-QFR) and triglyceride-glucose (TyG) index is crucial.

Purpose of the Study:

  • To investigate the prognostic impact of 3V-QFR and TyG index in patients after PCI.
  • To identify risk thresholds for 3V-QFR and TyG index in predicting major adverse cardiac events (MACEs).

Main Methods:

  • A cohort of 546 patients undergoing repeat angiography one year post-PCI were followed for four years.
  • Restricted cubic spline analysis determined risk thresholds for 3V-QFR and TyG index.
  • Major adverse cardiac events (MACEs) served as the primary endpoint.

Main Results:

  • Optimal cutoffs were identified as 2.44 for 3V-QFR and 8.75 for TyG index.
  • Patients with 3V-QFR < 2.44 showed significantly higher adverse event rates.
  • In patients with 3V-QFR ≥ 2.44, TyG index ≥ 8.75 was independently associated with increased MACEs (adjusted HR 1.51), primarily due to ischemia-driven revascularization.

Conclusions:

  • A 3V-QFR < 2.44 signifies residual functional ischemia and predicts poor prognosis after PCI.
  • In patients with complete functional revascularization, a high TyG index indicates elevated metabolic risk.
  • Combining physiological (3V-QFR) and metabolic (TyG) assessments enhances long-term risk stratification for secondary prevention.
Abstract

Keywords:
Coronary artery diseaseCoronary revascularizationInsulin resistanceMetabolic riskRisk stratification

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