The Predictive Value of Quantitative Flow Ratio and Its Derived Angiographic Microvascular Resistance for Restenosis Following Drug-Coated Balloon Angioplasty.

Abstract

Background: Initially, drug-coated balloon (DCB) angioplasty was primarily employed for in-stent restenosis (ISR) treatment. Over time, its indications have broadened to include de novo small-vessel lesions and bifurcation lesions. However, there is a lack of effective strategies to reduce restenosis rates post-DCB angioplasty.

Aims: Exploring the predictive value of quantitative flow ratio (QFR) and its derived angiographic microvascular resistance (AMR) for vascular restenosis following DCB angioplasty.

Methods: This study enrolled 108 patients who received DCB angioplasty during the period between February 2021 and October 2024. All patients underwent follow-up coronary angiography at 1 year post-procedure. Based on angiographic findings, patients were divided into a restenosis group (n = 38) and a non-restenosis group (n = 70). The study compared preoperative parameters, surgical data, and postoperative variables.

Results: The restenosis group demonstrated a significantly higher prevalence of diabetes (p < 0.05), greater history of smoking (p < 0.05), lower postoperative QFR values (p < 0.05), and a higher proportion of patients with AMR values exceeding 2.5 (p < 0.05) compared to the non-restenosis group. Multivariate logistic regression analysis identified postoperative QFR and high AMR values as independent predictors of restenosis after DCB therapy. ROC curve analysis demonstrated that the AUC for postoperative QFR in predicting restenosis was 0.727 (95% CI: 0.518-0.936, p < 0.05), which improved to 0.903 (95% CI: 0.782-1, p < 0.01) when combined with high AMR values.

Conclusions: Coronary angiography-derived QFR and AMR are closely associated with vascular restenosis in patients treated with DCB. Routine postoperative measurement of QFR and AMR may enhance risk prediction for restenosis following DCB angioplasty.