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

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.