Vessel and lesion selection for PCI using quantitative flow ratio (QFR) improved PCI outcomes compared with a standard angiography-guided strategy, according to findings from FAVOR III China presented at TCT 2021 and simultaneously published in The Lancet.

The multicenter, blinded, randomized, sham-controlled trial compared QFR-guided PCI with angiography-guided PCI in 3,825 patients with stable or unstable angina pectoris or those with more than 72 hours post-myocardial infarction who had at least one lesion with a diameter stenosis between 50% and 90% in a coronary artery with a reference vessel diameter of at least 2.5 mm by visual assessment.

The mean age of participants was 62 years and 70% were men. Additionally, 63.5% of patients presented with an acute coronary syndrome, 54% had multivessel disease and 33.9% had diabetes. Patients were randomized to a QFR-guided strategy (n=1,913) or an angiography-guided strategy (n=1,912) and all underwent a preset 10-minute delay for real or sham QFR calculation before PCI.

At one year, the primary endpoint of major adverse cardiac events (MACE) was 5.8% for the QFR-guided group compared with 8.8% for the angiography-guided group. The major secondary endpoint (one-year rate of MACE, excluding periprocedural myocardial infarction) was 3.1% for the QFR-guided group vs. 4.8% for the angiography-guided group.

“A QFR-guided vessel and lesion selection strategy improved one-year clinical outcomes compared with standard angiography guidance in patients undergoing PCI, due both to fewer procedural complications and superior long-term results.” said Bo Xu, MBBS, director of Catheterization Laboratories at Fuwai Hospital in Beijing, China. “The simplicity and safety of QFR compared with wire-based physiological measurements should facilitate the adoption of physiological lesion assessment into routine clinical practice.”

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Transcatheter Cardiovascular Therapeutics, TCT21, Percutaneous Coronary Intervention, Coronary Angiography, Fractional Flow Reserve, Myocardial, ACC International

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