Prognostic value of angiography-derived fractional flow reserve and translesion gradient after drug-coated balloon angioplasty

Angiography-derived fractional flow reserve (AccuFFRangio) has emerged as a reliable tool for coronary functional assessment, demonstrating high concordance with invasive fractional flow reserve (FFR). This study aimed to determine the previously uninvestigated predictive value of combining AccuFFRangio with translesion gradient (TLG) following drug-coated balloon (DCB) angioplasty. This retrospective study included 232 patients treated with DCB angioplasty. Post-DCB AccuFFRangio and TLG were successfully measured in 218 patients. The vessels were classified according to dichotomous post-DCB AccuFFRangio and TLG. The primary endpoint was 2-year risk of target vessel failure (TVF), which is a composite of target vessel revascularization, target vessel myocardial infarction (MI), and cardiac death. The optimal cutoff for post-DCB AccuFFRangio was 0.89. A post-DCB AccuFFRangio ≤0.89 was strongly associated with higher rates of TVF (14.3% vs. 2.8%; P=0.002), and a TLG of >0.03 was associated with increased rates of TVF (13.5% vs. 4.9%; P=0.046). Key predictors of adverse outcomes included male gender, smoking status, higher residual diameter stenosis, and post-DCB AccuFFRangio and TLG. In multivariate analysis, AccuFFRangio was independently predictive of TVF. The patient subgroup with high TLG and low AccuFFRangio had significantly higher rates of TVF (15.2%) as compared to the other groups (P=0.005). Immediate post-DCB AccuFFRangio and TLG can be effectively used for stratifying risk and predicting long-term outcomes in patients undergoing DCB angioplasty. Post-DCB AccuFFRangio, in particular, offers significant prognostic insights beyond traditional clinical and imaging parameters, suggesting its potential as a critical tool in postangioplasty patient management.