QFR measurements post CTO percutaneous coronary intervention: Can the long term outcome be predicted?

Background: QFR, a non-invasive tool using 3D coronary artery imaging and fluid dynamics, helps assess revascularization benefits in patients with coronary chronic total occlusion (CTO). Methods and Results: A retrospective study of 616 CTO patients who underwent PCI for CTO, with QFR assessed post-procedure. In a 5-year follow-up study involving 616 patients, the study used three tertiles (first tertile: QFR ≥ 0.88, second tertile: 0.85 ≤ QFR < 0.88, third tertile: QFR < 0.85) to determine the "cut-off" value. QFR showed strong predictive power with an area under the curve (AUC) of 0.80 (95 % confidence interval: 0.77-0.83, P < 0.001). The occurrence of MACCEs among all participants in the study was 28.4 %. This rate varied across different groups, with 63.9 % in the low QFR tertile, 14.8 % in the middle tertile, and 12.6 % in the high QFR group. During the follow-up period, a variation in the occurrence of MACCEs was observed among the three groups (P < 0.05). Analysis using Kaplan-Meier curves indicated a statistically major difference in the cumulative rates of MACCEs across the groups. Competing risk regression analysis indicated that QFR is negatively associated with all-cause mortality, cardiovascular mortality, and composite MACCEs. Conclusion: The study found a high prognostic value of physiological assessment using QFR after successful CTO intervention.