Clinical implication of quantitative flow ratio to predict clinical events after drug-coated balloon angioplasty in patients with in-stent restenosis

Clin Cardiol. 2021 Jul;44(7):978-986. doi: 10.1002/clc.23630. Epub 2021 May 19.

Abstract

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.

Keywords: drug-coated balloon; percutaneous coronary intervention; quantitative flow ratio.

MeSH terms

  • Angioplasty, Balloon, Coronary* / adverse effects
  • Coated Materials, Biocompatible
  • Constriction, Pathologic
  • Coronary Artery Disease*
  • Coronary Restenosis* / diagnostic imaging
  • Coronary Restenosis* / etiology
  • Drug-Eluting Stents*
  • Humans
  • Percutaneous Coronary Intervention*
  • Pharmaceutical Preparations*
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Coated Materials, Biocompatible
  • Pharmaceutical Preparations