Prognostic value of Murray law-based quantitative flow ratio after percutaneous coronary intervention
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Published on: August 25, 2023
Rui Zhang1, Jingjing Xu1, Changdong Guan2
1Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, National Clinical Research Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Background:
Post-percutaneous coronary intervention (PCI) physiological indices have prognostic relevance. Murray law-based quantitative flow ratio (μQFR) enables wire-free, rapid, single-view functional assessment, yet its long-term prognostic value after PCI remains incompletely established.
Aims:
We sought to evaluate the prognostic value of post-PCI μQFR for long-term adverse outcomes.
Methods:
This prespecified subgroup analysis of the FAVOR III China trial included 3,825 patients. All PCI-treated vessels with a reference diameter ≥2.5 mm and 50-90% diameter stenosis were analysed for offline post-PCI μQFR. The primary endpoint was 5-year major adverse cardiovascular events (MACE; including death from any cause, myocardial infarction, or ischaemia-driven revascularisation).
Results:
Post-PCI μQFR was successfully analysed in 4,196 vessels from 3,455 patients, with similar distributions between the randomised treatment groups. At 5 years, a low post-PCI μQFR was associated with a higher incidence of MACE compared with the intermediate and high post-PCI μQFR tertiles (23.1% vs 19.0% vs 17.2%; p=0.001). Using the highest tertile (μQFR>0.95) as a reference, adjusted hazard ratios (aHR) were 1.08 (95% confidence interval [CI]: 0.87-1.34) for the intermediate tertile (0.92-0.95) and 1.30 (95% CI: 1.06-1.60) for the lowest tertile (μQFR ≤0.91). Using a receiver operating characteristic-derived cutoff, MACE occurred more frequently in patients with post-PCI μQFR <0.94 (22.3% vs 17.4%, aHR 1.23, 95% CI: 1.04-1.47; p=0.02) than in those with post-PCI μQFR ≥0.94. No significant interaction was observed between treatment strategy and post-PCI μQFR (p for interaction=0.23).
Conclusions:
Post-PCI μQFR distributions were similar between treatment groups, but lower values were associated with higher 5-year adverse event risk without significant treatment interaction. Its limited binary discrimination supports use as a continuous metric for post-PCI physiological risk stratification. (ClinicalTrials.gov: NCT03656848).
