Impact of left anterior descending lesion location on midterm outcomes in patients undergoing left internal mammary artery grafting: a five-year cohort study integrating quantitative flow ratio assessment
BackgroundThe prognostic value of coronary artery bypass grafting (CABG) may be suboptimal when guided solely by anatomical stenosis severity. Quantitative flow ratio (QFR), a computational angiography-derived hemodynamic assessment tool, offers functional insights; however, its prognostic interplay...
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Frontiers Media S.A.
2025-08-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1605573/full |
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| author | Ziang Sun Yuhui Wu Rui Jiang Zeyu Chen Tianyu Wang Wenlong Yan Sumin Yang |
| author_facet | Ziang Sun Yuhui Wu Rui Jiang Zeyu Chen Tianyu Wang Wenlong Yan Sumin Yang |
| author_sort | Ziang Sun |
| collection | DOAJ |
| description | BackgroundThe prognostic value of coronary artery bypass grafting (CABG) may be suboptimal when guided solely by anatomical stenosis severity. Quantitative flow ratio (QFR), a computational angiography-derived hemodynamic assessment tool, offers functional insights; however, its prognostic interplay with lesion localization [proximal vs. mid-to-distal left anterior descending artery (LAD)] remains unclear. This study evaluates the impact of QFR-guided revascularization, stratified by LAD lesion location, on midterm clinical outcomes.MethodsA retrospective cohort of 481 patients undergoing left internal mammary artery (LIMA) to LAD grafting (2019–2023) was analyzed. Lesions were classified as proximal (Site 1) or mid-to-distal (Site 2) LAD and stratified by QFR thresholds (High: ≥0.80; Low: <0.80). The primary endpoint was 5-year major adverse cardiovascular and cerebrovascular events (MACCEs), assessed using Kaplan–Meier survival analysis and Cox regression.ResultsHigh QFR patients (n = 139) exhibited lower diabetes (28.1% vs. 40.6%, p = 0.013), smoking rates (27.3% vs. 38.6%, p = 0.025), and 3-vessel disease (48.9% vs. 74.6%, p < 0.0001) compared to low QFR (n = 342). Proximal lesions with high QFR had markedly higher MACCEs risk (HR = 1.91, 95% CI: 1.18–3.10; Log-rank P = 0.0075), whereas mid-to-distal lesions showed no QFR-driven prognostic differences (p = 0.46). Lesion location alone did not independently influence survival (Log-rank P = 0.8).ConclusionQFR-guided risk stratification is most prognostically impactful for proximal LAD lesions, where hemodynamic significance plays a critical role in clinical outcomes. In contrast, mid-to-distal lesions exhibit limited QFR utility, emphasizing anatomical-functional synergy in CABG planning. Despite comparable survival across lesion sites, proximal low QFR lesions warrant intensified surveillance. |
| format | Article |
| id | doaj-art-e5eed2f168bb41f08f0125663d24bb08 |
| institution | DOAJ |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-e5eed2f168bb41f08f0125663d24bb082025-08-20T02:58:11ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-08-011210.3389/fcvm.2025.16055731605573Impact of left anterior descending lesion location on midterm outcomes in patients undergoing left internal mammary artery grafting: a five-year cohort study integrating quantitative flow ratio assessmentZiang Sun0Yuhui Wu1Rui Jiang2Zeyu Chen3Tianyu Wang4Wenlong Yan5Sumin Yang6Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, ChinaDepartment of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, ChinaDepartment of DSA Room, The Affiliated Hospital of Qingdao University, Qingdao, ChinaDepartment of DSA Room, The Affiliated Hospital of Qingdao University, Qingdao, ChinaSchool of Medicine and Pharmacy, Ocean University of China, Qingdao, ChinaDepartment of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, ChinaDepartment of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, ChinaBackgroundThe prognostic value of coronary artery bypass grafting (CABG) may be suboptimal when guided solely by anatomical stenosis severity. Quantitative flow ratio (QFR), a computational angiography-derived hemodynamic assessment tool, offers functional insights; however, its prognostic interplay with lesion localization [proximal vs. mid-to-distal left anterior descending artery (LAD)] remains unclear. This study evaluates the impact of QFR-guided revascularization, stratified by LAD lesion location, on midterm clinical outcomes.MethodsA retrospective cohort of 481 patients undergoing left internal mammary artery (LIMA) to LAD grafting (2019–2023) was analyzed. Lesions were classified as proximal (Site 1) or mid-to-distal (Site 2) LAD and stratified by QFR thresholds (High: ≥0.80; Low: <0.80). The primary endpoint was 5-year major adverse cardiovascular and cerebrovascular events (MACCEs), assessed using Kaplan–Meier survival analysis and Cox regression.ResultsHigh QFR patients (n = 139) exhibited lower diabetes (28.1% vs. 40.6%, p = 0.013), smoking rates (27.3% vs. 38.6%, p = 0.025), and 3-vessel disease (48.9% vs. 74.6%, p < 0.0001) compared to low QFR (n = 342). Proximal lesions with high QFR had markedly higher MACCEs risk (HR = 1.91, 95% CI: 1.18–3.10; Log-rank P = 0.0075), whereas mid-to-distal lesions showed no QFR-driven prognostic differences (p = 0.46). Lesion location alone did not independently influence survival (Log-rank P = 0.8).ConclusionQFR-guided risk stratification is most prognostically impactful for proximal LAD lesions, where hemodynamic significance plays a critical role in clinical outcomes. In contrast, mid-to-distal lesions exhibit limited QFR utility, emphasizing anatomical-functional synergy in CABG planning. Despite comparable survival across lesion sites, proximal low QFR lesions warrant intensified surveillance.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1605573/fullquantitative flow ratio (QFR)coronary artery bypass grafting (CABG)left anterior descending artery (LAD)lesion localizationangiography |
| spellingShingle | Ziang Sun Yuhui Wu Rui Jiang Zeyu Chen Tianyu Wang Wenlong Yan Sumin Yang Impact of left anterior descending lesion location on midterm outcomes in patients undergoing left internal mammary artery grafting: a five-year cohort study integrating quantitative flow ratio assessment Frontiers in Cardiovascular Medicine quantitative flow ratio (QFR) coronary artery bypass grafting (CABG) left anterior descending artery (LAD) lesion localization angiography |
| title | Impact of left anterior descending lesion location on midterm outcomes in patients undergoing left internal mammary artery grafting: a five-year cohort study integrating quantitative flow ratio assessment |
| title_full | Impact of left anterior descending lesion location on midterm outcomes in patients undergoing left internal mammary artery grafting: a five-year cohort study integrating quantitative flow ratio assessment |
| title_fullStr | Impact of left anterior descending lesion location on midterm outcomes in patients undergoing left internal mammary artery grafting: a five-year cohort study integrating quantitative flow ratio assessment |
| title_full_unstemmed | Impact of left anterior descending lesion location on midterm outcomes in patients undergoing left internal mammary artery grafting: a five-year cohort study integrating quantitative flow ratio assessment |
| title_short | Impact of left anterior descending lesion location on midterm outcomes in patients undergoing left internal mammary artery grafting: a five-year cohort study integrating quantitative flow ratio assessment |
| title_sort | impact of left anterior descending lesion location on midterm outcomes in patients undergoing left internal mammary artery grafting a five year cohort study integrating quantitative flow ratio assessment |
| topic | quantitative flow ratio (QFR) coronary artery bypass grafting (CABG) left anterior descending artery (LAD) lesion localization angiography |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1605573/full |
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