Study on the evaluation efficacy of FFR and RFR in long-term prognostic risk of acute coronary syndrome patients after revascularization

Lyu Fengfeng; Zhao Lei; Lyu Yuanjie; Zhang Yanan; Teng Zhen

doi:10.3969/j.issn.1002-1949.2025.02.008

Abstract：Objective To study the evaluation efficacy of fractional flow reserve(FFR)and resting full-cycle ratio(RFR)in long-term prognostic risk of the patients with acute coronary syndrome(ACS)after revascularization.Methods A total of 389 ACS patients who received revascularization treatment in Cangzhou Central Hospital from January 2022 to October 2023 were selected.FFR and RFR were measured before treatment,and follow-up was conducted for 12 to 36 months after treatment.Based on whether major adverse cardiovascular events(MACE)occurred in the long-term prognosis of ACS patients after revascularization,they were divided into a poor prognosis group(with MACE occurrence,n=165)and a good prognosis group(without MACE occurrence,n=224).The differences in FFR and RFR before and after revascularization and clinical data between two groups were compared,and Cox regression analysis was used to identify the risk factors affecting MACE occurrence in ACS patients.Receiver operating characteristic(ROC)curve and Kaplan-Meier curve were used to analyze the value of FFR and RFR in evaluating the risk of MACE occurrence for long-term prognosis of ACS patients after revascularization.Results All 389 ACS patients included in the study completed the entire follow-up,and 165 patients had MACE with an incidence rate of 42.42％.The FFR and RFR of the poor prognosis group before and after revascularization were lower than those of the good prognosis group(P＜0.05).Cox regression analysis found that age,family history of coronary heart disease,diabetes,Killip grade of cardiac function,lymphocyte(LY),Gensini score,interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),brain natriuretic peptide(BNP),FFR,RFR were all risk factors for MACE in the long-term prognosis of ACS patients after revascularization(P＜0.05).The area under curve(AUC)of FFR before revascularization,FFR after revascularization,RFR before revascularization and RFR after revascularization for predicting the long-term prognosis of patients was 0.835,0.886,0.859 and 0.901,respectively.The best predictive performance was obtained when the cutoff values were 0.69.0.75,0.78 and 0.84,respectively.Further analysis of the combined predictive performance showed that the AUC of FFR combined with RFR before and after revascularization for predicting the long-term prognosis of patients was 0.925,indicating a significant improvement in predictive performance,with sensitivity of 0.901 and specificity of 0.855,respectively.Patients in the low FFR1 group,low FFR2 group,low RFR1 group and low RFR2 group had a higher risk of MACE(P＜0.05).Conclusions FFR and RFR are related to the long-term prognosis of ACS patients after revascularization and can be used for assessing the risk of MACE in prognosis.