The quantitative effects of integrating healthy lifestyles with depression on mortality remain unclear. A total of 19, 528 individuals from NHANES and 75, 785 participants from the UK Biobank were analyzed. The associations between combined healthy lifestyle and depression with mortality were evaluated using Cox proportional hazards regression and Kaplan–Meier survival curves. There were 855 or 2,286 instances of all-cause death and 249 or 405 instances of cardiovascular death, respectively. Participants exhibiting healthier lifestyle choices or better depression status had a reduced risk of death. Moreover, individuals adhering to a favorable lifestyle and concurrently staying mentally healthy had a reduced risk of all-cause and cardiovascular death compared to their counterparts (adjusted-HR: 0.37, 95

Aims:Coronary computed tomography angiography (CCTA) enables a non-invasive, comprehensive assessment of coronary artery disease, and artificial intelligence (AI) offers the potential to improve CCTA image interpretation. This study aimed to evaluate the performance of an AI-powered method for automatic plaque quantification from CCTA, with optical coherence tomography (OCT) as reference standard. Methods and results:Patients who underwent CCTA within 6 months prior to OCT were retrospectively enrolled. AI-assisted automatic plaque quantification was performed on CCTA with specific plaque composition classification based on adaptive Hounsfield unit thresholds. Qualitative high-risk plaque features were also assessed. Automated co-registration of CCTA and OCT was performed with the link of invasive coronary angiography. A total of 91 patients with 153 co-registered lesions were evaluated. The AI-assisted automatic CCTA analysis showed significant correlations with OCT for quantifying plaque volume/burden and different plaque compositions (all P values <0.001); of which, the correlation coefficient for plaque volume was 0.84. Vulnerable plaque, defined as lipid-to-cap ratio >0.33 on OCT, was identified in 39 (25.5%) lesions. CCTA-derived plaque volume >82.5 mm3 [odds ratio (OR), 9.39], maximal plaque burden >76.4% (OR, 3.70), lipidic tissue volume >16.3 mm³ (OR, 4.42), all P < 0.001, and high-risk plaque features ≥2 (OR, 2.70, P = 0.009) were independent predictors of OCT-derived vulnerable plaques. The average time for automatic CCTA plaque quantification was 1.8 min per patient. Conclusion:The novel AI-powered method facilitated fully automatic plaque quantification and correlated well with co-registered OCT.

Background: We investigated the predictive effects of four insulin resistance (IR) surrogate indices, namely homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride-glucose (TyG), metabolic score of insulin resistance (METS-IR), and estimated glucose disposal rate (eGDR), on the risk of death in adults with metabolic syndrome-like characteristics. Methods: We selected 11,841 individuals with metabolic syndrome-like characteristics from the National Health and Nutrition Examination Survey (NHANES) spanning the years 1999 to 2018. Tthe relationships between various IR surrogates and mortality were assessed through Cox proportional hazards regression. Results: Over a median follow-up period of 123 months, there were 1,742 cases of all-cause mortality and 479 instances of cardiovascular mortality. Compared with patients with eGDR ≤ 6.30, there was a significantly lower risk of all-cause mortality in the second, third and highest eGDR quartiles (adjusted hazard ratio [HR]: 0.80, 95% confidence interval [CI]: 0.68–0.95, P = 0.010; adjusted HR: 0.68, 95% CI: 0.55–0.85, P < 0.001; adjusted HR: 0.62, 95% CI: 0.46–0.84, P = 0.002, respectively; P for trend < 0.001). The eGDR showed a stronger correlation with all-cause mortality than HOMA-IR, TyG, and METS-IR, particularly among individuals under 60 years old. Notably, the relationship between eGDR and mortality showed a significant interaction with age (P for interaction < 0.001). Survival analysis further corroborated this discrepancy. Conclusions: The eGDR exhibited a more pronounced association with all-cause mortality among US adults presenting with metabolic syndrome-like characteristics, in comparison to the other three indices, particularly among individuals younger than 60 years.

Sepsis, a life-threatening syndrome with especially high incidence and mortality in older adults, imposes a major global health burden. Although the gut bacterial microbiota is known to influence sepsis pathogenesis, the role of the gut fungal community (mycobiota) and its functional metabolic output remains largely unknown. In this study, we characterized sepsis-associated alterations in the gut mycobiota and related plasma metabolic signatures, and explored their associations with age and survival outcomes. We conducted an integrated multi-omics analysis of fecal samples from patients with sepsis and matched healthy controls. Using internal transcribed spacer 1 (ITS1) sequencing and untargeted plasma metabolomics at admission, we compared the gut mycobiota composition and metabolic profiles between groups across age strata (non-older vs. older adults) and survival outcomes. Patients with sepsis exhibited significant gut mycobiota dysbiosis, characterized by a loss of diversity and marked overgrowth of opportunistic Candida. Metabolomics revealed distinct perturbations, particularly in the bile acid and inflammatory pathways. These alterations were profoundly exacerbated in non-survivors and elderly patients and were strongly correlated with higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, organ failure, and mortality. Our study identified a sepsis-specific gut mycobiota signature and associated plasma metabolomic disturbances that were associated with mortality and accentuated by aging. These findings reveal an association between the gut mycobiota, host metabolism, and clinical outcomes in sepsis, which merits further validation to assess its potential for prognostic or therapeutic applications. However, the causal relationship remains to be established, and future studies are needed to validate these associations and explore their translational potential.

Background We investigated the relationship of triglyceride-glucose (TyG), C-reactive protein-triglyceride glucose index (CTI), atherogenic index of plasma (AIP), metabolic score of insulin resistance (METS-IR), and estimated glucose discharge rate (eGDR), with cardio-metabolic risk and mortality.Methods A cohort of 312,380 participants was selected from the UK Biobank to investigate the associations between various surrogates and the incidence of major adverse cardiovascular events (MACE) and mortality.Results The study identified 12,223 cases of new-onset type 2 diabetes mellitus (T2DM), 42,504 cases of MACE. Compared to those with CTI <= 8.24, there was a significantly higher risk of developing new-onset T2DM and experiencing MACE as well as all-cause or cardiovascular mortality in the highest eGDR quartiles. Compared to those with eGDR <= 6.41, there was a significantly lower risk of developing new-onset T2DM and experiencing MACE as well as all-cause or cardiovascular mortality in the highest eGDR quartiles.Conclusions TyG index, CTI, AIP, and METS-IR have an increased risk of developing new-onset T2DM and MACE. Conversely, a higher eGDR was significantly associated with a reduced risk of both new-onset T2DM and MACE. The CTI and eGDR exhibited a more pronounced association with all-cause and cardiovascular mortality compared to other surrogate indexes.

Background:Patients with coronary artery disease (CAD) continue to face residual cardiovascular risk despite receiving guideline-directed optimal therapy. Both systemic metabolic-inflammatory dysregulation, reflected by the C-reactive protein-triglyceride glucose index (CTI), and coronary physiological burden, assessed by the quantitative flow ratio (QFR), are critical determinants of prognosis. However, the combined prognostic value of these two factors in patients after percutaneous coronary intervention (PCI) remains unclear. This study aimed to evaluate the prognostic value of an integrated index combining CTI with residual coronary physiological burden in patients undergoing PCI. Methods:This single-center registry study (ChiCTR2100042363) consecutively enrolled 1,468 patients with CAD who underwent PCI between March 2021 and February 2022. A novel integrated index, μCTI, was derived from the CTI and the sum of the residual QFR in the three major coronary vessels. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of all-cause death, non-fatal myocardial infarction (MI), ischemia-driven revascularization (IDR), or stroke. Results:During a median follow-up of 24 months, a total of 185 MACCE (12.6%) occurred. In multivariable Cox regression, each standard deviation increase in μCTI was independently associated with a 79% rise in MACCE risk [adjusted hazard ratio (HR) = 1.79, 95% CI: 1.54-2.07, p < 0.001]. Furthermore, MACCE risk progressively increased across ascending μCTI quartiles (P for trend < 0.001). Restricted cubic spline (RCS) analysis revealed a linear relationship between μCTI and MACCE risk (P for nonlinear = 0.058). Conclusion:The composite μCTI acts as an independent predictive biomarker and delivers supplementary risk stratification information for patients after PCI. This combined index could serve as an auxiliary tool to identify individuals at elevated risk of MACCE beyond single metabolic-inflammatory or coronary physiological indicators.

OBJECTIVES:We investigated the predictive value of the average microvascular resistance of the three main vessels (3VA-AMR) for the prognosis of patients with non-ST-segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI). METHODS:This study was conducted on patients with NSTEMI who underwent PCI between March 1, 2021, and February 28, 2022, at Fujian Medical University Union Hospital. Quantitative flow ratio (QFR) analysis was conducted on all patients' PCI angiography images to assess postoperative QFR and angio-based microvascular resistance (AMR) for three main vessels. All enrolled patients were devided into two groups based on the criteria for coronary microvascular dysfunction (CMD): high 3VA-AMR group and low 3VA-AMR group. The primary outcome was 2-year major adverse cardiac events (MACEs), including cardiovascular death, myocardial infarction, and ischemia-driven revascularization. RESULTS:A total of 290 patients were included in the final analysis. Compared with the low 3VA-AMR group, the three vessels of high 3VA-AMR group showed lower area stenosis (49.46 ± 13.70 % vs. 52.93 ± 15.43 %，P = 0.001), higher QFR value (0.92 ± 0.05 vs. 0.88 ± 0.09, P < 0.001), and higher AMR value (274.50 [257.33-301.42] mmHg*s/m vs. 208.00 [182.00-231.83] mmHg*s/m, P < 0.001). The incidence of 2-year MACEs was significantly higher in the high 3VA-AMR group than in the low 3VA-AMR group (21.90 % vs. 10.27 %, P = 0.007). Univariate and multivariate Cox regression analyses confirmed that 3VA-AMR was independently associated with 2-year MACEs (HR:1.007, 95 % CI:1.004-1.010, P < 0.001). The Kaplan-Meier method further confirmed the difference in 2-year MACE risk between two groups. Receiver operating characteristic curve analysis showed a significant correlation between 3VA-AMR and MACE (area under the curve: 0.701, P < 0.001). CONCLUSIONS:3VA-AMR was an independent risk factor for 2-year MACEs in NSTEMI patients. Compared with target-vessel AMR, 3VA-AMR demonstrated superior predictive value for 2-year MACEs following PCI.

This study investigates the association between mRNA levels of genes involved in 7-methylguanosine (m7G) metabolism and the prognosis of herpes zoster. By analyzing the transcriptional profiles of m7G-related genes in herpes zoster from the GSE242252 dataset, it was found that NSUN2, AGO2, and SNUPN were differentially expressed between herpes zoster and normal controls (p < 0.05). AGO2 and SNUPN were negatively correlated with multiple immune cell infiltrations, while NSUN2 was positively correlated with immature B cell infiltration. A nomogram model based on NSUN2, AGO2, and SNUPN was constructed and showed good predictive ability, validated through clinical impact curve analysis (CICA), calibration curve, and decision curve analysis (DCA). The results suggest that a nomogram based on NSUN2, AGO2, and SNUPN can predict the risk of herpes zoster, and the relationship between these genes and immune infiltration may influence the prognosis of herpes zoster. Trial registration: This study was approved by the Institutional Review Board of the Fujian Medical University Union Hospital (No 2023QH003).

BACKGROUND:Residual ischemia and metabolic dysregulation remain determinants of long-term prognosis after percutaneous coronary intervention (PCI). We investigated the prognostic impact of the three-vessel quantitative flow ratio (3V-QFR) and the triglyceride-glucose (TyG) index in this population. METHODS:A total of 546 patients who underwent repeat angiography one year after PCI were followed for four years. Restricted cubic spline analysis was used to determine risk thresholds for both 3V-QFR and TyG. The primary endpoint was major adverse cardiac events (MACEs). RESULTS:The optimal cutoffs for predicting MACEs were 2.44 for 3V-QFR and 8.75 for TyG. Patients with 3V-QFR < 2.44 experienced significantly higher adverse event rates. Among patients with 3V-QFR ≥ 2.44, TyG ≥ 8.75 was independently associated with increased MACEs (adjusted HR 1.51, 95 % CI 1.04-2.05), mainly driven by ischemia-driven revascularization. No such association was observed in patients with 3V-QFR < 2.44. CONCLUSIONS:3V-QFR < 2.44 reflects residual functional ischemia and portends poor prognosis after PCI. In patients with complete functional revascularization, a high TyG index indicates elevated metabolic risk. A combined physiological-metabolic assessment provides improved risk stratification for long-term secondary prevention.

Background: While serum uric acid (SUA) is known as a cardiovascular disease risk factor and is associated with increased cardiovascular mortality, the relationship between SUA and cardiovascular adaptability under exercise stress remains unclear. Aims: This study aims to elucidate the relationship between SUA levels and cardiovascular fitness, particularly as manifested during cardiopulmonary exercise testing. Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 1999–2004, this study included 5765 participants aged 12–49 years. Heart rate recovery (HRR) during cardiopulmonary exercise testing was measured as an indicator of cardiovascular fitness. Multivariate linear regression analysis was used to explore the association between SUA levels and heart rate recovery at 1 min (HRR1) and 2 min (HRR2) post-exercise. Results: After adjusting for potential confounders, an inverse relationship was found between SUA levels and both HRR1 and HRR2. Multivariate adjusted smoothing spline plots demonstrated a decrease in HRR1 and HRR2 with increasing SUA levels. This negative correlation was observed across nearly all subgroups. Conclusions: Elevated SUA levels are indicative of poorer cardiovascular adaptability in the adult US population.

Background: Revascularized patients still experience adverse cardiovascular events. This is particularly true for elderly patients over the age of 65, as they often have more co-morbid vascular conditions. It is important to develop a tool to assist clinicians in comprehensively assessing these patients’ prognosis. The objective of this study is to create a comprehensive visual nomogram model combining clinical and physiological assessments to predict outcomes in elderly patients undergoing percutaneous coronary intervention (PCI). Methods: This study is a retrospective investigation of patients who underwent PCI between January 2016 and December 2017. A total of 691 patients with 1461 vessels were randomly divided into a training (n = 483) and a validation set (n = 208). A multivariate Cox regression model was employed using the training set to select variables for constructing a nomogram. The performance of the nomogram was assessed through the receiver operating characteristic curve (ROC) and calibration curves to evaluate its discrimination and predictive accuracy. To further assess the clinical usefulness, Kaplan–Meier curve analysis and landmark analysis were conducted. Results: Independent risk factors, including diabetes mellitus (DM), post-PCI quantitative flow ratio (QFR), previous myocardial infarction (MI), and previous PCI, were contained in the nomogram. The nomogram exhibited a good area under the curve (AUC) ranging from 0.742 to 0.789 in the training set, 0.783 to 0.837 in the validation set, and 0.764 to 0.786 in the entire population. Calibration curves demonstrated a well-fitted curve in all three sets. The Kaplan–Meier curves showed clear separation and the patients with higher scores in the nomogram model exhibited a higher incidence of target vessel revascularization (TVR) (7.99% vs. 1.24% for 2-year, p < 0.001 and 13.54% vs. 2.23% for 5-years, p < 0.001, respectively). Conclusions: This study has developed the visually intuitive nomogram to predict the 2-year and 5-year TVR rates for elderly patients who underwent PCI. This tool provides more accurate and comprehensive healthcare guidance for patients and their physicians.

Objective: the Controlling Nutritional Status (CONUT) score is an objective tool widely used to assess nutritional status of patients. We aimed to investigate the value of CONUT score on predicting length of hospital stay (LOS) and the risk of long COVID in patients with COVID-19. Methods: a total of 151 patients with COVID-19 were enrolled for analysis. Patients were followed up for two years from three months after the onset of SARS-CoV-2 infection. CONUT score was calculated on admission. The correlation between CONUT score and LOS were assessed by Spearman's rank correlation coefficient and multivariate linear analysis. The association between different CONUT grade and long COVID was evaluated by Kaplan-Meier survival curves with log-rank test and Cox proportional hazard models. Results: Spearman's rank correlation coefficient showed that CONUT scores were positively correlated with LOS (r = 0.469, p < 0.001). Multivariate linear analysis showed that CONUT score is the only independent determinant of LOS (B 2.055, 95 % CI: 1.067-3.043, p < 0.001). A total of 53 (35.10 %) patients with long COVID were identified. Kaplan-Meier cumulative survival curves and Cox proportional hazards analyses showed that the incidence of long COVID in patients with a higher CONUT score was significantly higher than in patients with lower CONUT score (p < 0.001). Conclusions: higher CONUT score predicts longer LOS and the risk of long COVID in patients with COVID-19. The CONUT score might be useful for risk stratification in COVID-19 patients and help to develop new nutritional treatment strategies for long COVID.

BACKGROUND: Quantitative flow ratio (QFR)-based virtual percutaneous coronary intervention (PCI) is associated with improved post-PCI physiological results. Murray law-based QFR (mu QFR) is a new method for physiological assessment that has higher feasibility and efficiency. The purpose of this study was to investigate the performance of mu QFR-guided virtual PCI in improving post-PCI outcomes. METHODS: The QUITE RIGHT study (Quantitative Flow Ratio Virtual Stenting and Angiography Guided Percutaneous Coronary Intervention) is a prospective, multicenter, blinded, randomized, controlled superiority study. Eligible patients were randomized 1:1 to either the mu QFR-guided virtual PCI group or the angiography-guided PCI group. The primary end point was the proportion of the target vessels with a post-PCI mu QFR >= 0.90, accepted as an optimal post-PCI physiological outcome. RESULTS: A total of 622 patients with 666 vessels were enrolled. The optimal physiological outcome was reached more often in the mu QFR-guided virtual PCI group (absolute difference, 9.1% [95% CI, 4.53-13.76]; P<0.001). The mu QFR-guided virtual PCI group had a better QFR value, a lower contrast agent dose and x-ray dose, and a more appropriate stent length than the angiography-guided group. CONCLUSIONS: The QUITE RIGHT study showed that the mu QFR-guided virtual PCI strategy is superior to angiography-guided PCI in terms of physiological outcomes. The mu QFR-guided virtual PCI strategy is associated with lower contrast and x-ray doses and a more appropriate stent length. REGISTRATION:URL: https://www.chictr.org.cn/; Unique identifier: ChiCTR2100045452.

IntroductionTo investigate the prognostic value of the consistency between the residual quantitative flow ratio (QFR) and postpercutaneous coronary intervention (PCI) QFR in patients undergoing revascularization.MethodsThis was a single-center, retrospective, observational study. All enrolled patients were divided into five groups according to the ΔQFR (defined as the value of the post-PCI QFR minus the residual QFR): (1) Overanticipated group; (2) Slightly overanticipated group; (3) Consistent group; (4) Slightly underanticipated group; and (5) Underanticipated group. The primary outcome was the 5-year target vessel failure (TVF).ResultsA total of 1373 patients were included in the final analysis. The pre-PCI QFR and post-PCI QFR were significantly different among the five groups. TVF within 5 years occurred in 189 patients in all the groups. The incidence of TVF was significantly greater in the underanticipated group than in the consistent group (P = 0.008), whereas no significant differences were found when comparing the underanticipated group with the other three groups. Restricted cubic spline regression analysis showed that the risk of TVF was nonlinearly related to the ΔQFR. A multivariate Cox regression model revealed that a ΔQFR≤ −0.1 was an independent risk factor for TVF.ConclusionsThe consistency between the residual QFR and post-PCI QFR may be associated with the long-term prognosis of patients. Patients whose post-PCI QFR is significantly lower than the residual QFR may be at greater risk of TVF. An aggressive PCI strategy for lesions is anticipated to have less functional benefit and may not result in a better clinical outcome.

Background: Dual stenting technique (DST) is still mandatory for some true bifurcation lesions (BLs), but drug-coated balloon (DCB) alone may offer a new optional treatment with the potential benefits of fewer implants. However, procedural safety presents a concern when using DCB-only to treat true BLs. This study sought to explore the safety and efficacy of the DCB-only strategy for the treatment of true BLs. Methods: Sixty patients with TBLs were randomly assigned to be treated by a DCB-based strategy or DST-based strategy. All patients received angiographic follow-up scheduled after one-year and staged clinical follow-up. The primary endpoint was the one-year late lumen loss (LLL) and cumulative major cardiac adverse events (MACEs) composed of cardiac death (CD), target vessel myocardial infarction (TVMI), target lesion thrombosis (TVT), or target vessel/lesion revascularization (TLR/TVR). The secondary endpoint was the one-year minimal lumen diameter (MLD), diameter stenosis percentage (DSP) or binary restenosis (BRS), and each MACE component. Results: The baseline clinical and lesioncharacteristics were comparable with similar proportions (20.0% vs. 23.3%, p = 1.000) of the complex BLs between the two groups. At the one-year follow-up, LLL was significantly lower in the DCB-based group (main-vessel: 0.05 ± 0.24 mm vs. 0.25 ± 0.35 mm, p = 0.013; side-branch: –0.02 ± 0.19 mm vs. 0.11 ± 0.15 mm, p = 0.005). MLD, DSP and TLR/TVR were comparable between the groups. The one-year cumulative MACE, all driven by TLR/TVR (6.7% vs. 13.3%, p = 0.667), was low and similar without CD, TVMI or TVT in both groups. Conclusions: Compared to the DST strategy, the DCB- based strategy may be safe and effective in treatment of the selected true BLs. Clinical Trial Registration: Clinical registration number is ChiCTR1900024914.

OBJECTIVE:To analyze the association of resting heart rate (RHR) with the prognosis of patients with post-infarction ventricular aneurysms. METHODS:We retrospectively analyzed the clinical data of 227 patients with post-infarction ventricular aneurysms admitted to our hospital during 2017-2019. The endpoint event was the occurrence of any major adverse cardiovascular and cerebrovascular events (MACCEs) during the follow-up for 24 months. According to RHR measurements, the patients were divided into 3 groups with baseline RHR < 10%, 10%-90%, and >90%. The Cox proportional risk model and restricted cubic spline (RCS) model were used to analyze the effect of RHR on MACCEs. RESULTS:During the 24-month followup, 90 patients (39.6%) experienced MACCEs. The fully adjusted RCS curves showed a nonlinear "U" shaped correlation between RHR and the occurrence of MACCEs. In the fully adjusted model, the risk of MACCEs increased by 3.01-fold (Hazard ratio [HR]=4.01, 95% CI: 2.07-7.76, P < 0.001) in patients with RHR>90%, as compared with patients with RHR of 10%-90%. In patients with RHR in 1-9th percentile, 10th-90th percentile and 91st-100th percentile, the incidences of MACCEs were 39.1%, 36.6% and 66.7% (P=0.027), the incidences of ventricular tachycardia/ventricular fibrillation (VT/VF) were 17.4%, 2.7% and 4.8% (P=0.005), and the incidences of readmission for heart failure were 8.7%, 26.8% and 42.9% (P=0.036), respectively. CONCLUSION:Continuous monitoring and management of heart rate range may provide guidance for prognosis prediction in patients with post-infarction ventricular aneurysms.

目的 探讨中青年美国人群中血清尿酸(SUA)与心血管自主神经系统功能之间的关系.方法 检索美国全国健康和营养检查调查数据库的数据,收集1999-2004年完成心肺运动测试患者资料,采用心肺运动测试中的心率恢复(HRR)评价心血管自主神经功能,HRR1或HRR2为受试者在心肺运动中达到峰值或症状限制时的最大心率与心肺运动测试后恢复1或2 min时的心率差值.通过多元线性回归分析研究SUA与HRR1或HRR2之间的关系.结果 共2 968例受试者最终纳入研究,年龄18～49岁,平均(29.02±9.73)岁,平均HRR1为(11.19± 7.15),平均HRR2为(29.61±11.55),平均SUA水平为(5.14±1.35)mg/dl.本研究发现在调整潜在混杂因素后,SUA与HRR1或HRR2呈负相关.多变量调整平滑曲线表明HRR1和HRR2随着SUA水平的增加而降低,上述关联在根据协变量分层的分层分析中仍存在.结论 中青年美国人群尿酸和心血管自主神经功能障碍有明确相关,应重视高尿酸患者的自主神经功能评估.

AIMS:We aimed to investigate the impact of percutaneous coronary intervention (PCI) and diabetes mellitus (DM) on short- and long-term prognosis in patients with coronary artery disease using three-vessel quantitative flow ratio (3 V-QFR) assessment. METHODS:A retrospective analysis of 2440 vessels in 1181 patients who underwent PCI was performed. The patients were categorized according to the presence or absence of DM and the median 3 V-QFR. The primary outcome was the occurrence of major adverse cardiac events (MACE), defined as a combination of cardiovascular death, myocardial infarction, and ischemia-driven revascularization, over a 5-year period. RESULTS:The pre-PCI and post-PCI 3 V-QFR values for the entire population were 2.37 (2.04-2.56) and 2.94 (2.82-3.00), respectively. Landmark analysis showed that the incidence of MACE was comparable among all groups within the first year (log-rank p = 0.088). Over the course of 2 years, the incidence of MACE was higher in both groups with a post-PCI 3 V-QFR < 2.94 (log-rank p < 0.001). However, from 2 to 5 years, patients with DM had higher rates of MACE (log-rank p = 0.013). CONCLUSIONS:In the short term, a low post-PCI 3 V-QFR is a predictor of high risk for MACE. However, in the long term, DM emerges as the dominant risk factor.

目的 分析定量血流分数(QFR)指导急性ST段抬高型心肌梗死(STEMI)合并多支血管病变患者非梗死相关血管血运重建的手术耗费和临床获益.方法 回顾性收集2019年1月—2020年12月急诊行经皮冠状动脉介入治疗(PCI)且合并多支血管病变的159例STEMI患者,根据是否采用QFR指导非梗死相关血管PCI分为Q FR指导组和造影指导组,比较两组处理非梗死相关血管的例均手术器械消耗和手术花费、1 a无净不良临床事件(NACE,定义为1 a全因死亡、再发心肌梗死、所有再次血运重建、因心力衰竭住院、卒中、严重出血的累积事件)和无主要不良心血管事件(M ACE,定义为1 a心脏性死亡、再发心肌梗死、缺血驱动血运重建的累积事件)生存率.结果 QFR指导组所使用的指引导管、指引导丝、预扩张球囊、后扩张球囊及支架总数分别为(0.86±0.35)根、(0.97±0.51)条、(0.74±0.55)个、(0.86±0.55)个和(1.12±0.68)枚,明显少于造影指导组[(1.01±0.11)根,P<0.001]、[(1.12±0.33)条,P=0.029]、[(0.90±0.49)个,P=0.041]、[(1.11±0.57)个,P=0.005]和[(1.33±0.59)枚,P=0.033];Q FR指导组的手术费用较造影指导组减少近16.5％[(2.60±0.26)万元v s(2.17±0.91)万元,P<0.001];QFR指导组累积1 a无NACE和无MACE生存率分别为91.0％ 和93.6％,略优于造影指导组的86.4％ 和91.4％,差别无统计学意义(P>0.05).结论 Q FR指导的非梗死相关血管血运重建策略的手术耗费更低,但临床获益与造影指导的非梗死相关血管血运重建策略类似.