Post‐PCI quantitative flow ratio predicts 3‐year outcome after rotational atherectomy in patients with heavily calcified lesions

Abstract

Background The study sought to investigate the clinical predictive value of quantitative flow ratio (QFR) for the long‐term outcome in patients with heavily calcified lesions who underwent percutaneous coronary intervention (PCI) following rotational atherectomy (RA). Methods In this retrospective study, 393 consecutive patients from 2009 to 2017 were enrolled. The QFR of the entire target vessel (QFRv) and the QFR of the stent plus 5 mm proximally and distally (in‐segment) (QFRi) were measured. The primary endpoint was target lesion failure (TLF), including target lesion‐cardiac death (TL‐CD), target lesion‐myocardial infarction (TL‐MI), and clinically driven‐target lesion revascularization (CD‐TLR). Results A total of 224 patients with 224 calcified lesions completed the clinical follow‐up, and 52 patients had TLF. There was no significant difference in QFRv post‐PCI between non‐TLF and TLF groups ( p > .05). However, QFRi post PCI was significantly higher in the non‐TLF group than in the TLF group. Multivariate Cox regression showed that QFRi post‐PCI was an excellent predictor of TLF after a 3‐year follow‐up (HR 1.7E −8 [5.3E −11 –5.6E ‐6 ]; p < .01). Furthermore, receiver‐operating characteristic curve analysis demonstrated that the optimal cutoff value of QFRi for predicting the long‐term TLF was 0.94 (area under the curve: 0.826, 95% confidence interval: 0.756–0.895; sensitivity: 89.5%, specificity: 69.2%; p < .01). The QFRi ≤ 0.94 post‐PCI was negatively associated with TLF, including TL‐CD, TL‐MI, and CD‐TLR ( p < .01). Conclusions QFRi post‐PCI showed a high predictive value for TLF for during a 3‐year follow‐up in patients who underwent PCI following RA; specifically, lower QFRi values post‐PCI were associated with worse TLF.

Prognostic Value of Post-PCI Angiography-Derived Fractional Flow Reserve: A Systematic Review and Meta-Analysis of Cohort Studies

“…The studies used in our meta-analysis included patients with both stable coronary disease and acute coronary syndromes, as well as different clinical scenarios such as in-stent restenosis lesions, indicating that lower post-PCI angiography-derived FFR values are predictive of adverse events in a wide spectrum of coronary artery disease. In most of the included studies, the QFR was used as the method of FFR estimation via angiography [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. The QFR is a well-studied index of coronary physiology.…”

“… RR and 95% CI for lower angiography-derived FFR values and total cardiovascular (CV) events (( A ) based on cut-off values [ 16 , 17 , 18 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]; ( B ) per 0.1 increase [ 19 , 20 , 21 ]), target vessel revascularization ( C ) [ 16 , 18 , 22 , 23 , 24 , 25 , 26 ], cardiac death ( D) [ 16 , 18 , 22 , 23 , 24 , 25 , 28 ], target vessel myocardial infarction ( E ) [ 16 , 18 , 22 , 23 , 24 , 25 ] and target lesion revascularization ( F ) [ 16 , 22 , 28 ]. The squares’ sizes show the weight of each study, and the lines illustrate the 95% CI for individual studies with a lower and upper limit.…”

“… Hazard ratios (HRs) of total cardiovascular events in patients with lower angiography-derived FFR values as an impact of ( A ) age (data from 12 studies [ 16 , 17 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 36 ]); ( B ) the study’s population follow-up period (data from 12 studies [ 16 , 17 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 36 ]); ( C ) cut-off value (data from 12 studies [ 16 , 17 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 36 ]); ( D ) the percentage of the study population with diabetes mellitus (data from 12 studies [ 16 , 17 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 36 ]); ( E ) the percentage of the study population, who were smokers (data from 11 studies [ 16 , 17 , 19 , …”

“…The immediate post-stenting measurement of the FFR could aid in optimizing revascularization results and potentially improve outcomes as it is well established that suboptimal PCI is an independent predictor of major cardiac adverse events [ 13 , 14 , 15 ]. Recent studies demonstrated the role of the post-PCI angiography-derived FFR as a predictor of a vessel- or patient-oriented outcomes in patients with stable CAD, acute coronary syndromes, or in-stent restenosis [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. The primary objective of this meta-analysis was to evaluate whether the post-PCI angiography-derived FFR predicts coronary adverse events in CAD patients undergoing PCI.…”

Prognostic value of quantitative flow ratio in patients with coronary heart disease after percutaneous coronary intervention therapy: a meta-analysis

“…Bar et al defined a cut-off value of QFR = 0.80 in the study, which led to a low sensitivity of QFR (23.4%). You et al investigated the clinical predictive value of QFRi (quantitative flow ratio in a segment) for the long-term outcome in patients who had heavily calcified lesions ( 21 ). These patients underwent PCI with rotational atherectomy.…”