Long‐Term Vessel‐Oriented Outcomes After PCI in Routine Japanese Practice: A Retrospective Quantitative Flow Ratio Analysis With 2‐Year Landmark Evaluation

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BACKGROUND: Post-PCI vessel quantitative flow ratio (QFR) and QFR virtual pullback (QVP) index reflect postprocedural physiological quality and the residual disease pattern after percutaneous coronary intervention (PCI), but their associations with very-long-term vessel-oriented composite endpoint (VOCE) remain uncertain. AIMS: We examined whether the relationships of post-PCI vessel QFR and QVP index with vessel-oriented outcomes differed over time. METHODS: We retrospectively reconstructed a 2010-2011 PCI cohort and expanded follow-up to 12 years. Among 900 treated vessels/lesions, 595 with analyzable post-PCI QFR were included. Kaplan-Meier curves with a 2-year landmark, restricted cubic splines, and multivariable Cox models were used to compare determinants of 2-year versus overall VOCE. RESULTS: Among 900 treated vessels/lesions, post-PCI vessel QFR was analyzable in 595 (573 patients; 575 procedures). Mean post-PCI vessel QFR was 0.93 ± 0.07, and 76.0% of vessels achieved post-PCI vessel QFR ≥ 0.91. Kaplan-Meier estimated 2-year VOCE was 1.9% (11 early events). Neither post-PCI vessel QFR nor QVP index was significantly associated with 2-year VOCE in restricted cubic spline analyses (P for overall association = 0.175 and 0.449, respectively; P for nonlinearity = 0.281 and 0.478, respectively) or in conventional Cox models. For overall VOCE, age and diabetes mellitus were the dominant correlates. CONCLUSIONS: In this imaging-intensive historical PCI cohort with few early events, neither post-PCI vessel QFR nor QVP index demonstrated a statistically significant association with 2-year VOCE. Very-long-term VOCE was more strongly related to age and diabetes mellitus, and the present findings do not establish a role for post-PCI QFR-derived indices in early risk stratification.

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