ArticleCardiovascular diagnosis and therapy2026
Beyond borderline physiology: determinants of treatment choice and phenotypes of outcome in QFR grey-zone lesions.
Article in Cardiovascular diagnosis and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The management of coronary lesions with quantitative flow ratio (QFR) values in the grey zone (0.75-0.85) remains a common clinical dilemma, with uncertain outcomes and unclear determinants guiding treatment selection in real-world practice. This study aimed to identify the clinical and angiographic factors influencing real-world treatment selection and compare clinical outcomes of percutaneous coronary intervention (PCI) versus medical therapy in the QFR grey zone. Methods: This retrospective study analyzed 297 coronary lesions with borderline QFR values (0.75-0.85). Patients were stratified by treatment (PCI Results: Among 297 patients with coronary lesions in the QFR grey-zone (0.75-0.85), PCI (n=101) was performed for lesions with greater anatomic severity (smaller MLD, higher DS% and AS%, all P<0.001), while medical therapy (n=196) was favored for patients with higher HbA1c and proBNP (P=0.006 and P=0.02, respectively) and for lesions with length >20 mm (74.5% Conclusions: In patients with QFR grey-zone lesions, treatment selection balanced anatomic severity against clinical complexity. While overall outcomes were similar between strategies, impaired LVEF (≤45%) identified a high-risk phenotype for whom medical therapy was associated with worse outcomes, and poor glycemic control independently predicted TVF across the entire cohort. These findings suggest that a personalized approach-potentially including a lower threshold for revascularization in patients with reduced LVEF and intensified risk factor management in those with poor glycemic control-merits further investigation in prospective studies.
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