| Objective:This study aims to further determine the predictive value of μQFR for the prognosis of related side branches of coronary bifurcation lesions after PCI by analyzing the prognosis of side branches under different μQFR values after PCI and the change of μQFR values,so as to optimize interventional treatment strategies for coronary bifurcation lesions to improve clinical benefits and long-term prognosis of patients.Methods:This was a retrospective cohort study.Firstly,we preliminarily screened patients who were hospitalized due to coronary atherosclerotic heart disease and received PCI from January 2018 to September 2022 in the Department of Cardiovascular Medicine of Affiliated Hospital of Yunnan University,and who came to the hospital for Re-CAG at 12-months follow-up.Patients with non-left main coronary bifurcation lesions were further filtered by retrospective analysis of coronary angiography images.The coronary angiography images of patients were downloaded from the imaging system,and the offline QFR analysis was further performed in the core laboratory.Finally,115 patients(128 lesions)were enrolled according to the inclusion and exclusion criterion.According to the μQFR value of important side branches of target vessels after PCI,they were divided into good function group(μQFR value > 0.8)and poor function group(μQFR value≤0.8).the good function group includes 76 cases(86lesions)and the poor function group includes 39 cases(42 lesions);and then comparing the baseline datum of the two groups,including gender,age,hypertension,diabetes,dyslipidemia,chronic kidney disease,previous smoking,previous PCI history,clinical diagnosis,left ventricular ejection fraction(LVEF),peak of cardiac markers during hospitalization,follow-up time,oral medication during follow-up,target vessels and important side branches,Medina classification,etc.Offline μQFR analysis includes the μQFR value of the main vessel before and after PCI,the μQFR value of important side branches before and after PCI,and the μQFR value of the main vessel and important side branches at 12-months follow-up.the two-dimensional QCA is derived from μQFR,which is the structural parameters of the target vessel,including minimum lumen diameter(MLD)of main vessel reference lumen diameter of main vessel,diameter stenosis(DS)of main vessel,area stenosis(AS)of main vessel,ostium diameter of side branch,reference diameter of side branch,minimum lumen diameter of side branch,minimum lumen area(MLA)of side branch,PBA(Angle between the side branch origin and the proximal main vessel),DBA(Angle between the side branch origin and the distal main vessel),etc.and then comparing the incidence of periprocedural myocardial infarction(PMI)between the two groups during hospitalization,the incidence of target vessel revascularization(TVR),the incidence of acute and long-term side branch occlusion.and then comparing theμQFR value of main vessel and side branch,ΔμQFR value of side branch(ΔμQFR value = μQFR value at 12-months follow-up-μQFR value immediately after PCI)between the two groups.Finally,the predictive value of μQFR on the prognosis of related side branches after PCI for coronary bifurcation lesions was determined.Results:1.A total of 115 patients(128 CBLs)were enrolled in the final analysis and there was no significant difference in clinical data compared with excluded 10 patients.poor function group and good function group were performed in 39(42 lesions)and76(86 lesions)patients.The mean age of the patients was 63.1±10.3 years.There were 75(58.6%)lesions involved left anterior descending coronary artery and107(83.6%)true CBLs.The demographic and clinical characteristics(including sex ratio,gender,age,hypertension,diabetes,dyslipidemia,chronic kidney disease,previous smoking,previous PCI history,clinical diagnosis,left ventricular ejection,target vessel,and Medina classification)between two groups had no significant difference(P>0.05).2.There was no significant difference between the two groups in cardiac markers(c TNI,CK-MB),follow-up time,and oral drugs(including aspirin,clopidogrel,ticagrelor,statins,β-blockers,ACEI/ARB,calcium channel blockers,nitrates,trimetazidine and nicorandil)during follow-up(P>0.05).3.There was no significant difference between the two groups in minimum lumen diameter of main vessel,reference lumen diameter of main vessel,diameter stenosis of main vessel,area stenosis of main vessel,ostium diameter of side branch,reference diameter of side branch,minimum lumen diameter of side branch,minimum lumen area of side branch,PBA and DBA(P>0.05).4.There was no significant difference between the two groups in the μQFR value of main vessel before PCI,the μQFR value of main vessel after PCI and the μQFR value of main vessel at 12-months follow-up(P>0.05).the μQFR value of side branch immediately after PCI of the good function group was higher than that of the poor function group[0.92(0.88-0.97)vs 0.70(0.69-0.80)],and the difference between the two groups was statistically significant(P<0.001);the μQFR value of side branch at 12-months follow-up of the good function group was higher than that of the poor function group[0.95(0.92-0.98)vs 0.67(0.70-0.85)],and the difference between the two groups was statistically significant(P<0.001);although there was no significant difference in ΔμQFR of side branch between the two groups(P>0.05);but the proportion of ΔμQFR > 0 was more than 50%(64.8%)in all patients,and the proportion of ΔμQFR >0 of the good function group was significantly greater than that of the poor function group(75.6% vs 42.9%),and the difference between the two groups was statistically significant(P<0.001).5.The incidence of PMI during hospitalization of the poor function group was significantly higher than of the good function group(10.3% vs 0.0%),and the difference between the two groups was statistically significant(P=0.021);The incidence of acute side branch occlusion.of the poor function group was significantly higher than of the good function group(7.1% vs 0.0%),the difference between the two groups was statistically significant(P=0.034);The incidence of long-term side branch occlusion of the poor function group was significantly higher than of the good function group(9.5% vs 0.0%),and the difference between the two groups was statistically significant(P=0.018).although the incidence of TVR of the poor function group was higher than of the good function group(9.5% vs 3.5%),but the difference between the two groups was not statistically significant(P=0.319).Conclusion(s):1.The higher the μQFR value of side branches after PCI,the lower the risk of periprocedural complications and the better the long-term prognosis.2.In evaluating the prognosis of coronary bifurcation lesions,μQFR has significant practical advantages and may be a reliable non-invasive alternative indicator of FFR. |
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