Clinical Predictive Value For Long-term Outcome Of Quantitative Flow Ratio Post Percutaneous Coronary Intervention Following Rotational Atherectomy For Patients With Severely Calcified Lesions

OBJECTIVES:The study sought to investigate the clinical predictive value for long-term outcome of quantitative flow ratio(QFR)for patients who underwent percutaneous coronary intervention(PCI)following rotational atherectomy(RA)for severe calcified lesions.Methods:393 Patients with severe coronary calcified disease who underwent PCI following RA and completed clinical follow-up data were eligible enrolled in this retrospective study between July 2015 and November 2018.QFR of the entire target vessel(QFRv)and QFR of the stent plus 5 mm proximally and distally(in-segment)(QFRi)were measured for analysis offline.The primary endpoint was TLF,defined as a composite of target vessel related cardiac death(TL-CD),target vessel related myocardial infarction(TL-MI),and clinically indicated target lesion revascularization(TLR)by coronary artery bypass graft surgery(CABG)or PCI.Results:A total of 224 calcified lesions in 224 patients completed the clinical follow-up data.The median follow-up duration was 1095 days,and 52 TLF cases occurred.QFRi post PCI were significantly high in the no TLF group compared to the TLF group.Multivariable Cox regression analyzed QFRi post-PCI was an excellent predictor for TLF 3-year follow-up(HR 1.7E-8[5.3E-11-5.6E-6];p<0.01).Receiver-operating characteristic curve analysis demonstrated the optimal cut-off value of QFRi post-PCI for predicting the long-term TLF was 0.94(area under the curve:0.826,95%CI:0.756-0.895;sensitivity:89.5%,specificity:69.2%;p<0.01).The QFRi ≤ 0.94 post PCI was strongly correlated with the TLF,including TL-CD,TL-MI,and CD-TLR(p<0.01).Conclusion:QFRi post-PCI showed a high predictive value of TLF for a 3-year follow-up in patients underwent elective PCI following RA,and the lower QFRi post PCI was associated with the worse TLF.