Predictors of vessel quantitative flow ratio loss in patients with severely calcified lesions after rotational atherectomy.

Abstract

Previous studies have established that moderately to severely calcified lesions (MSCL) are associated with high rates of major adverse cardiovascular events, even when drug-eluting stents are implanted after rotational atherectomy (RA). Yet, the changes in coronary function indexes during follow-ups have never been investigated. The quantitative flow ratio (QFR), a novel coronary function index, has been increasingly adopted in daily practice in recent years. A total of 111 MSCL patients were retrospectively enrolled in this study. The vessel QFR (QFRv) loss was defined as post-percutaneous coronary intervention QFRv minus follow-up QFRv. The study subjects were divided into high QFRv loss (n = 51) and low QFRv loss (n = 60) groups according to the binary method. The obtained predictors of QFRv loss were then analyzed. The results showed that the final burr-to-vessel ratio (B to V ratio) in the high QFRv loss group decreased significantly compared to the low QFRv loss group (p < 0.01). The univariate and multivariate regression analyses indicated that the final B to V ratio was an excellent predictor of QFRv loss. The cut-off value of the final B to V ratio for QFRv loss prediction was 0.50 (sensitivity: 50.98%, specificity: 68.33%, and area under the curve: 0.627 [95% confidence interval: 0.530-0.717], p < 0.05). Additionally, the target vessel failure incidence in the high QFRv loss group was higher than in the low QFRv loss group (p < 0.01). An increased burr-to-vessel ratio can prevent QFRv loss in patients with MSCLs after RA, an effect that might be closely associated with a low target vessel failure incidence.