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Research Article: Ultrasonic flow ratio versus Murray law-based quantitative flow ratio for predicting target vessel failure after IVUS-guided PCI

Date Published: 2026-07-28

Abstract:
Residual ischemia after percutaneous coronary intervention (PCI) is closely associated with adverse clinical outcomes. Murray law-based quantitative flow ratio (?QFR), derived from coronary angiography, has demonstrated prognostic value after PCI. Ultrasonic flow ratio (UFR), derived from intravascular ultrasound (IVUS), integrates intravascular imaging with computational physiological assessment; however, its prognostic performance relative to ?QFR in patients undergoing IVUS-guided PCI remains insufficiently defined. This retrospective single-center study included 127 patients who underwent IVUS-guided PCI at the Sandun Campus of Zhejiang Hospital between January 2021 and December 2022 and completed follow-up coronary angiography during the follow-up period. UFR and ?QFR were measured at the distal exit of the most distal stent. The primary endpoint was target vessel failure (TVF). Receiver operating characteristic curve analysis and Cox proportional hazards regression were performed. Among the 127 included patients, 19 developed TVF and 108 remained free of TVF. Compared with the non-TVF group, the TVF group had significantly lower minimum stent expansion rate, mean stent expansion rate, and post-PCI UFR. UFR showed the highest discriminatory ability for TVF and significantly outperformed ?QFR. In multivariable analysis, only post-PCI UFR remained independently associated with TVF. These findings suggest that IVUS-derived anatomical-functional assessment may provide additional value for post-PCI risk stratification.

Introduction:
Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Although percutaneous coronary intervention (PCI) improves outcomes in patients undergoing revascularization, adverse events related to residual myocardial ischemia may still occur after the procedure ( 1 ). Assessment based on coronary angiography alone may fail to identify residual physiological impairment or suboptimal stent results in some patients. Therefore, accurate post-PCI risk stratification remains clinically…

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