A post-procedural quantitative flow ratio ≤ 0.94 after drug-coated balloon angioplasty for in-stent restenosis was associated with a significantly higher risk of 1-year adverse clinical events (HR 6.53).
Cohort (n=177)
Yes
Does post-procedural QFR predict vessel-oriented composite endpoints in patients undergoing drug-coated balloon angioplasty for in-stent restenosis?
Post-procedural QFR ≤ 0.94 is a strong independent predictor of 1-year adverse clinical events after drug-coated balloon angioplasty for DES in-stent restenosis.
Effect estimate: HR 6.53 (95% CI 2.70-15.8)
Absolute Event Rate: 33.9% vs 5.6%
p-value: p=<0.001
BACKGROUND: The association between the quantitative flow ratio (QFR) and adverse events after drug-coated balloon (DCB) angioplasty for in-stent restenosis (ISR) lesions has not been investigated. HYPOTHESIS: Post-procedural QFR is related to adverse events in patients undergoing DCB angioplasty for ISR lesions. METHODS: This retrospective study included data from patients undergoing DCB angioplasty for drug-eluting stent (DES) ISR between January 2016 and February 2019. The QFR was measured at baseline and after DCB angioplasty. The endpoint was the vessel-oriented composite endpoint (VOCE), defined as a composite of cardiac death, vessel-related myocardial infarction, and ischemia-driven target vessel revascularization. RESULTS: Overall, 177 patients with 185 DES-ISR lesions were included. During 1-year follow-up, 27 VOCEs occurred in 26 patients. The area under curve (AUC) of the post-procedural QFR was statistically greater than that of the in-stent percent diameter stenosis (0.77, 95% confidence interval CI 0.67-0.87 vs. 0.64, 95% CI 0.53-0.75; p = .032). Final QFR cutoff of 0.94 has the best predictive accuracy for VOCE. A QFR > 0.94 was associated with a lower risk of VOCE compared to a QFR ≤ 0.94 (log-rank test, p < .0001). Survival analysis using the multivariable Cox model showed that a post-procedural QFR ≤ 0.94 was an independent predictor of 1-year VOCE (hazard ratio 6.53, 95% CI 2.70-15.8, p < .001). CONCLUSIONS: A lower QFR value was associated with worse clinical outcomes at 1 year after DCB angioplasty for DES-ISR.
Tang et al. (Wed,) conducted a cohort in Drug-eluting stent in-stent restenosis (DES-ISR) (n=177). Post-procedural QFR ≤ 0.94 vs. Post-procedural QFR > 0.94 was evaluated on Vessel-oriented composite endpoint (VOCE) at 1 year (HR 6.53, 95% CI 2.70-15.8, p=<0.001). A post-procedural quantitative flow ratio ≤ 0.94 after drug-coated balloon angioplasty for in-stent restenosis was associated with a significantly higher risk of 1-year adverse clinical events (HR 6.53).
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