Pre-PCI QFR-PPG (OR 0.012; 95% CI 0.001-0.113; p=0.001) and IMR-angio significantly predicted suboptimal post-PCI FFR in patients with chronic coronary syndrome.
Cohort (n=402)
Do pre-PCI QFR-derived indices (QFR-PPG and angio-IMR) predict suboptimal revascularization and long-term adverse events in patients with chronic coronary syndrome undergoing elective PCI?
Pre-PCI QFR-derived indices, specifically QFR-PPG and angio-IMR, are valuable tools for predicting suboptimal hemodynamic outcomes and long-term major adverse cardiac events following elective PCI in patients with chronic coronary syndrome.
Effect estimate: OR 0.012 (95% CI 0.001-0.113)
p-value: p=0.001
Abstract Background Virtual assessments using Quantitative Flow Ratio (QFR) provide a QFR-derived pullback pressure gradient (QFR-PPG) and an angiography-based index of microcirculatory resistance (angio-IMR). The predictive value of these indices for immediate post–percutaneous coronary intervention (PCI) results and long-term clinical outcomes remains unknown. Purpose This study sought to investigate the predictive value of QFR-derived indices for both short-term and long-term clinical outcomes in patients with chronic coronary syndrome (CCS). Methods This retrospective study included patients with CCS who underwent elective PCI for de novo, functionally significant lesions (invasive fractional flow reserve ≤0.80) and had both pre- and post-PCI physiological assessments, as well as angiographic images suitable for QFR evaluation. We examined whether pre-PCI QFR-derived indices were associated with suboptimal revascularization, defined as a post-PCI FFR ≤0.80, as well as with vessel-oriented composite outcomes (VOCO) and major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, heart failure, stroke, and ischemia-driven revascularization. Results A total of 402 CCS patients undergoing elective PCI for a de novo lesion were included. The median pre- and post-PCI FFR values were 0.70 and 0.86, respectively. Among these patients, 81 (20.1%) had suboptimal post-PCI FFR (≤0.80), 32 (8.0%) experienced VOCO, and 70 (17.4%) developed MACE during a median follow-up of 4.1 years. In multivariate analysis, the QFR-PPG index (OR: 0.012, 95% CI: 0.001–0.113, p=0.001) and IMR-angio (OR: 0.965, 95% CI: 0.939–0.990, p=0.008) were significant predictors of suboptimal post-PCI FFR. After adjustment for post-PCI FFR, IMR-angio was significantly associated with MACE (HR: 0.965, 95% CI: 0.942–0.989, p=0.004) but not with VOCO (HR: 0.969, 95% CI: 0.933–1.007, p=0.110). Conclusion Pre-PCI pathophysiological evaluations using QFR-derived indices demonstrated significant predictive efficacy for identifying suboptimal hemodynamic outcomes and long-term adverse events following PCI. These indices may serve as valuable tools for predicting both acute and long-term outcomes and could help guide a more personalized, aggressive management strategy after PCI.
Kanaji et al. (Sat,) conducted a cohort in Chronic coronary syndrome (n=402). Quantitative Flow Ratio (QFR)-derived indices was evaluated on Suboptimal revascularization (post-PCI FFR ≤0.80) (OR 0.012, 95% CI 0.001-0.113, p=0.001). Pre-PCI QFR-PPG (OR 0.012; 95% CI 0.001-0.113; p=0.001) and IMR-angio significantly predicted suboptimal post-PCI FFR in patients with chronic coronary syndrome.