Prognostic Value of Angiography-Derived Fractional Flow Reserve Following Drug-Coated Balloon Angioplasty.

BACKGROUND: The role of post-procedural physiological assessment after drug-coated balloon (DCB) percutaneous coronary intervention (PCI) remains poorly defined. Angiography-derived indices such as μQFR provide a non-wire-based alternative to traditional physiological measurements, yet their prognostic value following DCB-PCI has not been established. AIMS: To explore the association between post-procedural μQFR and target lesion revascularization (TLR) in patients undergoing DCB angioplasty for de novo coronary lesions. METHODS: This analysis included consecutive patients from the prospective SIROOP registry undergoing DCB-PCI for de novo coronary lesions. Post-procedural μQFR was assessed offline using a dedicated angiography-derived physiology software (AngioPlus, Pulse Medical Imaging Technology, Shanghai, China). Patients were stratified according to a post-procedural μQFR cutoff of 0.80 (≤ 0.80 vs. > 0.80). The primary endpoint was clinically driven TLR at 2-year follow-up. RESULTS: A total of 205 patients were analyzed, of whom 51 (24.9%) had a post-procedural μQFR ≤ 0.80 and 154 (75.1%) had a μQFR > 0.80. Baseline clinical characteristics were similar between groups. During 2-year follow-up, TLR occurred in nine patients (4.4%). Kaplan-Meier analysis demonstrated no significant difference in TLR according to post-procedural μQFR groups (log-rank p = 0.488). CONCLUSIONS: In patients undergoing DCB-PCI for de novo coronary lesions, post-procedural angiography-derived physiological assessment using μQFR was not associated with clinically driven TLR at 2-year follow-up when applying a cutoff of 0.80. These findings underscore the need for prospective studies to clarify the role of angiography-derived physiology after DCB-PCI.