靶血管预处理后μQFR可预测药物涂层球囊治疗冠状动脉原位病变患者VOCE事件的发生

μQFR after target vessel pretreatment can predict the occurrence of VOCE events in patients with de novo coronary artery disease treated with drug-coated balloon

摘要:

目的]探究靶血管预处理后基于Murray定律的定量血流分数(μQFR)对药物涂层球囊治疗冠状动脉原位病变患者术后血管相关不良事件的预测价值。 [方法]本回顾性研究共纳入223例患者的223处病变,所有患者仅行单纯药物涂层球囊治疗,未植入任何支架,并进行2年的临床随访。收集病变血管术前、预处理后及术后的造影图像,并运用μQFR新算法进行分析。每条靶血管的μQFR分析除了靶血管μQFR值外,还包括靶血管病变长度、血管直径狭窄程度、参考管腔直径、最小管腔直径及血流速度。主要终点定义为术后血管相关复合终点(VOCE)。 [结果]2年临床随访期间,共25例(占11.2%)患者发生VOCE事件。与对照组相比,预处理后发生VOCE事件患者的μQFR降低(P＜0.001)。多因素Logistic分析显示,预处理后较低的靶血管μQFR(OR＝0.931,95%CI:0.894～0.969,P＜0.001)是VOCE事件的独立预测因素。ROC曲线分析显示,预处理后μQFR预测2年VOCE事件的截断值为0.83(95%CI:0.727～0.840),灵敏度为72.7%,特异度为84.0%(AUC＝0.773,95%CI:0.676～0.870,P＜0.001)。生存分析表明,与μQFR＞0.83的患者相比,μQFR≤0.83的患者在1年和2年随访期间VOCE事件的发生率显著升高,分别增加至3.909倍(16.9%比4.6%,HR＝3.909,95%CI:1.539～9.930,P＝0.004)和2.867倍(19.7%比7.2%,HR＝2.867,95%CI:1.301～6.316,P＝0.009)。校正潜在混杂因素后,预处理后μQFR≤0.83的患者2年VOCE事件的发生风险增加至2.567倍(HR＝2.567,95%CI:1.151～5.727,P＝0.021),1年血管不良事件的发生风险增加至3.712倍(HR＝3.712,95%CI:1.478～9.810,P＝0.006)。 [结论]对冠状动脉原位病变患者,预处理后较低的μQFR增加术后不良临床事件风险,μQFR≤0.83或可用于评估病变预处理效果。

Abstract:

Aim To investigate the predictive value of the Murray law-based quantitative flow ratio (μQFR) after target vessel pretreatment for vascular-related adverse events in patients with de novo coronary lesions treated with drug-coated balloon. Methods This retrospective study included 223 lesions from 223 patients who underwent drug-coated balloon-only strategy and completed 2-year clinical follow-up. Coronary angiographic images of target vessels pre-procedure, post-balloon and post-procedure were collected, and analyzed using a novel Murray's law-based algorithm. The μQFR analysis of each target vessel included not only the μQFR value of the target vessel, but also the length of the target vessel, the degree of vessel diameter stenosis, the reference lumen diameter, the minimum lumen diameter and blood flow velocity. The primary endpoint was defined as the postoperative vessel-oriented composite endpoint (VOCE). Results During the 2-year clinical follow-up period, a total of 25 patients (11.2%) experienced VOCE events. Compared with the control group, patients with VOCE events after pretreatment showed a decrease in μQFR (P＜0.001). Multivariate Logistic analysis showed that a lower target vessel μQFR after pretreatment (OR＝0.1,5%CI:0.894～0.969, P＜0.001) was an independent predictor of VOCE events. ROC curve analysis showed that the cut-off value for predicting 2-year VOCE events using preprocessed μQFR was 0.83 (95%CI:0.727～0.840), with a sensitivity of 72.7% and a specificity of 84.0% (AUC＝0.3,5%CI:0.676～0.870, P＜0.001). Survival analysis showed that compared with patients with μQFR＞0.83, patients with μQFR≤0.83 had a significantly higher incidence of VOCE events at 1 and 2 years, increasing to 3.909 times (16.9% vs. 4.6%, HR＝3.9,5%CI:1.539～9.930, P＝0.004) and 2.867 times (19.7% vs. 7.2%, HR＝2.7,5%CI:1.301～6.316, P＝0.009). After adjusting for potential confounds, patients with pretreated μQFR≤ 0.83 had a 2.567 times in 2-year incidence of VOCE events (HR＝2.7,5%CI:1.151～5.727, P＝0.021) and a 3.712 times in 1-year incidence of VOCE events (HR＝3.2,5%CI:1.478～9.810, P＝0.006) compared to patients with good pretreatment. Conclusions For patients with in situ coronary artery disease, a lower μQFR after pretreatment increases the risk of postoperative adverse clinical events. μQFR≤0.83 may be used to evaluate the effectiveness of lesion pretreatment.