Physiology-guided PCI using either angiography or microcatheter-derived fractional flow reserve (FFR) was superior to conventional angiography in achieving optimal post-PCI FFR values in patients undergoing complex and high-risk procedures (CHIP), based on findings from the AQVA II trial presented Oct. 23 during TCT 2023 and simultaneously published in JACC: Cardiovascular Interventions.

Simone Biscaglia, MD, et al., randomized 305 patients with obstructive coronary lesions and meeting CHIP criteria to receive physiology-guided (n=204) or conventional angiography-based (n=101) PCI. Those patients randomized to physiology-guided PCI were further randomized to either angiography- or microcatheter-derived FFR. The primary outcome was invasive post-PCI FFR value, with the optimal value defined as >0.86.

Overall results found procedural planning and optimization based on coronary physiology to be superior to conventional angiography-based PCI in achieving the primary endpoint (77% vs. 54%; absolute difference 23%, relative difference 30%, p>0.0001). Additionally, angiography-derived and microcatheter-derived FFR were equally effective for PCI guidance, according to the authors.

Looking ahead, Biscaglia and colleagues conclude that “the next step is to definitively demonstrate that a planning and optimization of PCI procedure based on coronary physiology can significantly reduce adverse events.”

JACC Journals are publishing 32 simultaneous publications coinciding with TCT 2023 research. View the full list on JACC.org.