A 2-year prognostic assessment of patients with coronary borderline lesions based on three-vessel quantitative flow ratio and the development and internal validation of a risk prediction nomogram
4 affiliations
- 1Affiliated Ordos Clinical College of Inner Mongolia Medical University, Ordos City, Inner Mongolia, China
- 2Department of Cardiovascular Medicine, Ordos Central Hospital, Ordos, Inner Mongolia, China
- 3Graduate School of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
- 4Department of Cardiovascular Medicine, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
Abstract
Objective: To investigate the prognostic value of three-vessel quantitative flow ratio (3V-QFR) in patients with borderline coronary lesions (QFR 0.75–0.80) over a 2-year period; to identify key variables using LASSO regression; and to construct and internally validate a personalized nomogram model for predicting major adverse cardiovascular events (MACE) over 2 years.
Methods: This single-center retrospective cohort study included patients with coronary artery disease who were treated at Ordos Central Hospital from January 2021 to December 2024, underwent coronary angiography revealing at least one borderline lesion in a major coronary artery, and received a QFR assessment. Patients were followed for up to 24 months after discharge through outpatient visits, telephone follow-up, and electronic medical-record review. The primary endpoint was defined as the occurrence of MACE during the 2-year follow-up period. Restricted cubic spline (RCS) analysis was used to explore the nonlinear relationship between 3V-QFR and the risk of MACE. Least absolute shrinkage and selection operator (LASSO) penalized regression evaluated 19 prespecified candidate predictors using 10-fold cross-validation and the one-standard-error rule. A nomogram was constructed based on the selected factors, and the model’s discriminatory power, consistency, and clinical net benefit were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Internal validation used 1,000 bootstrap resamples that repeated the complete preprocessing, variable-selection, and model-refitting pipeline.
Results: A total of 138 patients with borderline lesions were enrolled (33 in the MACE group and 105 in the non-MACE group). Among 33 first MACE events, 20 were ischemia-driven revascularizations, 9 were non-fatal myocardial infarctions, and 4 were all-cause deaths. RCS analysis showed an overall association between lower 3V-QFR and higher MACE risk, whereas evidence for nonlinearity was not statistically strong; multivariable regression supported 3V-QFR as an independent predictor. LASSO regression identified four optimal predictors of 2-year MACE through 10-fold cross-validation: 3V-QFR, age, diabetes, and NT-proBNP levels. The final model included 3V-QFR, age, diabetes, and NT-proBNP. The apparent AUC was 0.869 (95% CI 0.802–0.936), and the optimism-corrected AUC was 0.842 (95% CI 0.771–0.913); calibration and decision-curve findings were considered exploratory.
Conclusion: Lower 3V-QFR was associated with higher 2-year MACE risk in this retrospective development cohort. The 3V-QFR-based nomogram showed promising internal performance and may support exploratory risk stratification; independent external and prospective validation is required before clinical use.
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BibTeX
@article{bai20262year,
title = {{A 2-year prognostic assessment of patients with coronary borderline lesions based on three-vessel quantitative flow ratio and the development and internal validation of a risk prediction nomogram}},
author = {Hua Bai and Rigun A and Gang Zhang and Zhijie Guo and Dahai Bing and Yajiang Zhang and Peng Liu and Xi Liu},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1907097},
url = {https://doi.org/10.3389/fcvm.2026.1907097},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - A 2-year prognostic assessment of patients with coronary borderline lesions based on three-vessel quantitative flow ratio and the development and internal validation of a risk prediction nomogram
AU - Hua Bai
AU - Rigun A
AU - Gang Zhang
AU - Zhijie Guo
AU - Dahai Bing
AU - Yajiang Zhang
AU - Peng Liu
AU - Xi Liu
PY - 2026
DA - 2026/10/12
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1907097
UR - https://doi.org/10.3389/fcvm.2026.1907097
AB - Objective: To investigate the prognostic value of three-vessel quantitative flow ratio (3V-QFR) in patients with borderline coronary lesions (QFR 0.75–0.80) over a 2-year period; to identify key variables using LASSO regression; and to construct and internally validate a personalized nomogram model for predicting major adverse cardiovascular events (MACE) over 2 years. Methods: This single-center retrospective cohort study included patients with coronary artery disease who were treated at Ordos Central Hospital from January 2021 to December 2024, underwent coronary angiography revealing at least one borderline lesion in a major coronary artery, and received a QFR assessment. Patients were followed for up to 24 months after discharge through outpatient visits, telephone follow-up, and electronic medical-record review. The primary endpoint was defined as the occurrence of MACE during the 2-year follow-up period. Restricted cubic spline (RCS) analysis was used to explore the nonlinear relationship between 3V-QFR and the risk of MACE. Least absolute shrinkage and selection operator (LASSO) penalized regression evaluated 19 prespecified candidate predictors using 10-fold cross-validation and the one-standard-error rule. A nomogram was constructed based on the selected factors, and the model’s discriminatory power, consistency, and clinical net benefit were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Internal validation used 1,000 bootstrap resamples that repeated the complete preprocessing, variable-selection, and model-refitting pipeline. Results: A total of 138 patients with borderline lesions were enrolled (33 in the MACE group and 105 in the non-MACE group). Among 33 first MACE events, 20 were ischemia-driven revascularizations, 9 were non-fatal myocardial infarctions, and 4 were all-cause deaths. RCS analysis showed an overall association between lower 3V-QFR and higher MACE risk, whereas evidence for nonlinearity was not statistically strong; multivariable regression supported 3V-QFR as an independent predictor. LASSO regression identified four optimal predictors of 2-year MACE through 10-fold cross-validation: 3V-QFR, age, diabetes, and NT-proBNP levels. The final model included 3V-QFR, age, diabetes, and NT-proBNP. The apparent AUC was 0.869 (95% CI 0.802–0.936), and the optimism-corrected AUC was 0.842 (95% CI 0.771–0.913); calibration and decision-curve findings were considered exploratory. Conclusion: Lower 3V-QFR was associated with higher 2-year MACE risk in this retrospective development cohort. The 3V-QFR-based nomogram showed promising internal performance and may support exploratory risk stratification; independent external and prospective validation is required before clinical use.
SN - 2297-055X
ER -