What is the clinical evidence from this study?

Study design: Observational. Population: De novo lesions in small coronary artery disease (n=286). Intervention: Low post-PCI QFR (< 0.86) vs. High post-PCI QFR (≥ 0.86). Primary outcome: Major adverse cardiovascular events (MACE) (HR 3.632, 95% CI 1.872-7.044, p=<0.001).

December 26, 2024Open Access

Prognostic implications of increased and final quantitative flow ratios in patients treated with drug-coated balloons physiological evaluation after DCB in de novo lesions

Q: What are the key findings of this study?

A low post-PCI quantitative flow ratio (<0.86) after drug-coated balloon treatment in small coronary disease was associated with a significantly higher risk of major adverse cardiovascular events (HR 3.632).

Resultado clave

A low post-PCI quantitative flow ratio (<0.86) after drug-coated balloon treatment in small coronary disease was associated with a significantly higher risk of major adverse cardiovascular events (HR 3.632).

Diseño del estudio

Tipo

Observational (n=286)

Multicéntrico

Sí

PICO estructurado

Does post-PCI quantitative flow ratio (QFR) and ΔQFR predict major adverse cardiovascular events in patients with de novo small coronary lesions treated with drug-coated balloons?

Población

286 patients with de novo lesions of small coronary disease treated with drug-coated balloon (DCB) only

Intervención

High post-PCI quantitative flow ratio (QFR ≥ 0.86) or high post-PCI ΔQFR (≥ 0.57)

Comparador

Low post-PCI QFR (< 0.86) or low post-PCI ΔQFR (< 0.57)

Resultado

Major adverse cardiovascular events (MACE), including target vessel revascularization (TVR), cardiac death, and myocardial infarction (MI)composite

Post-PCI QFR and ΔQFR are independent predictors of MACE in patients with de novo small coronary lesions treated with drug-coated balloons, suggesting their utility for physiological evaluation after DCB.

Resultado numérico

Estimación del efecto: HR 3.632 (95% CI 1.872-7.044)

Tasa de eventos absoluta: 27% vs 5.7%

valor p: p=<0.001

Limitaciones

Focused on small coronary disease, requiring more investigation for large coronary vessels.
Did not use post-PCI QFR and ΔQFR to guide the PCI procedure.
Linear approach to defining the vessel is not appropriate for assessing the functional relevance of side branches.
Only 74.0% of patients completed the binary follow-up angiography, potentially decreasing the accuracy of late lumen loss measurements.

Resumen

BACKGROUND: Few studies investigated the implications of post-PCI QFR and post-PCI ΔQFR (absolute increase of QFR) in de novo lesions of small coronary disease after drug-coated balloon (DCB). OBJECTIVES: We sought to investigate the prognostic implications of post-PCI QFR and post-PCI ΔQFR in patients who received DCB only. METHODS: Patients were divided according to the optimal cutoff value of the post-PCI QFR and the post-PCI ΔQFR. The primary outcome was major adverse cardiovascular events (MACE), including target vessel revascularization (TVR), cardiac death, and myocardial infarction (MI). RESULTS: The optimal cutoff values of QFR and ΔQFR for the MACE rate were 0.86 and 0.57, respectively. There were 175 patients (61.2%) with a high QFR (≥ 0.86) and 113 patients (39.5%) with a high ΔQFR (≥ 0.57) after PCI. The MACE rate was significantly higher in patients with a low QFR compared to a high QFR (5.7% vs. 27.0%, hazard ratio HR: 3.632, 95% confidence interval CI: 1.872 to 7.044, P < 0.001). The MACE rate was higher in patients with a low ΔQFR increase compared to those with high ΔQFR (4.4% vs. 20.2%, HR: 4.700, 95%CI: 2.430 to 9.089, P = 0.001). In multivariable model, a low post-PCI QFR and a low post-PCI ΔQFR was independent predictor of MACE (adjusted HR: 4.071, 95%CI: 2.037 to 8.135, P = 0.001). CONCLUSIONS: After DCB in de novo lesions of small coronary disease, both post-PCI QFR and ΔQFR showed similar prognostic implications in MACE.

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Cite This Study

Li et al. (Thu,) conducted a observational in De novo lesions in small coronary artery disease (n=286). Low post-PCI QFR (< 0.86) vs. High post-PCI QFR (≥ 0.86) was evaluated on Major adverse cardiovascular events (MACE) (HR 3.632, 95% CI 1.872-7.044, p=<0.001). A low post-PCI quantitative flow ratio (<0.86) after drug-coated balloon treatment in small coronary disease was associated with a significantly higher risk of major adverse cardiovascular events (HR 3.632).

synapsesocial.com/papers/6a0bd9789ead71e723c212ed https://doi.org/https://doi.org/10.1186/s12872-024-04413-w

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