Effect of Low-Density Lipoprotein Cholesterol Goal Achievement on Vascular Physiology Evaluated by Quantitative Flow Ratio in Patients Who Underwent Percutaneous Coronary Intervention

Abstract

Purpose: The change in coronary physiology from lipid-lowering therapy (LLT) lacks an appropriate method of examination. Quantitative flow ratio (QFR) is a novel angiography-based approach allowing rapid assessment of coronary physiology. This study sought to determine the impact of low-density lipoprotein cholesterol (LDL-C) goal achievement on coronary physiology through QFR.Methods: Cases involving percutaneous coronary intervention (PCI) and 1-year angiographic follow-up were screened and assessed by QFR analysis. Patients were divided into two groups according to the LDL-C level at the 1-year follow-up: (1) goal-achievement group (LDL-C < 1.8 mmol/L or reduction of ≥50%, n = 146, lesion = 165) and (2) non-achievement group (n = 286, lesion = 331). All QFR data and major adverse cardiovascular and cerebrovascular events (MACCEs) at 1 year were compared between groups.Results: No differences between the groups in quantitative coronary angiography (QCA) data or QFR post-PCI were found. At the 1-year follow-up, lower percentage diameter stenosis (DS%) and percentage area stenosis (AS%) were recorded in the goal-achievement group (27.89 ± 10.16 vs. 30.93 ± 12.03, p = 0.010, 36.57 ± 16.12 vs. 41.68 ± 17.39, p = 0.003, respectively). Additionally, a better change in QFR was found in the goal-achievement group (0.003 ± 0.068 vs. −0.018 ± 0.086, p = 0.007), with a lower incidence of physiological restenosis and MACCEs (2.1 vs. 8.4%, p = 0.018, 5.4 vs. 12.6%, p = 0.021, respectively).Conclusion: Evaluated by QFR, patients who achieved the LDL-C goal appear to have a better coronary physiological benefit. This group of patients also has a better clinical outcome.

Impact of diabetes on coronary physiology evaluated by quantitative flow ratio in patients who underwent percutaneous coronary intervention

“…Thus, we believe that it makes sense to track the coronary physiology by the QFR during follow up to further guide treatment strategies after revascularization. Finally, intensive glucose control, dyslipidemia management and early follow up might contribute to the improvement of coronary physiology in such patients 5 , 36 , 37 , 38 .…”

Prognostic Implications of Changes in Total Physiological Atherosclerotic Burden in Patients With Coronary Artery Disease –A Serial Quantitative Flow Ratio Study

“…A recent serial coronary CTA study by Yu et al [23], on the basis of 153 low-risk patients with mild to intermediate coronary stenosis, suggested that rosuvastatin treatment could improve hemodynamic status for non-calcified plaques assessed by lesion-specific CT-derived FFR. Another 2 recently published serial QFR studies showed that a close relationship exists between the on-treatment LDL cholesterol level and coronary functional progression as evaluated by per-vessel QFR in patients with residual stenosis after PCI [24,25]. These results support the benefits of intensive lipid-lowing therapies on atherosclerosis regression from a physiological aspect.…”

Predictors of vessel quantitative flow ratio loss in patients with severely calcified lesions after rotational atherectomy

“…Additionally, Nozue et al [ 26 ] reported that DS was significantly determinant for coronary computed tomography angiography-derived fractional flow reserve (FFR CT ). Moreover, Chen et al [ 27 ] revealed, after adjusting, through QRF, the low-density lipoprotein cholesterol goal for coronary physiology, that the goal-achievement group exhibited lower DS with a better change in QFR and a lower incidence of major adverse cardiovascular events at 1-year follow-up [ 27 ]. Interestingly, our study’s DS follow-up was also lower in the LQ loss patients compared to their HQ loss counterparts.…”