2-Year Outcomes of Angiographic Quantitative Flow Ratio-Guided Coronary Interventions

Lei Song; Bo Xu; Shengxian Tu; Changdong Guan; Zening Jin; Bo Yu; Guosheng Fu; Yujie Zhou; Jian'an Wang; Yundai Chen; Jun Pu; Lianglong Chen; Xinkai Qu; Junqing Yang; Xuebo Liu; Lijun Guo; Chengxing Shen; Yaojun Zhang; Qi Zhang; Hongwei Pan; Rui Zhang; Jian Liu; Yanyan Zhao; Yang Wang; Kefei Dou; Ajay J Kirtane; Yongjian Wu; William Wijns; Weixian Yang; Martin B Leon; Shubin Qiao; Gregg W Stone; FAVOR III China Study Group

doi:10.1016/j.jacc.2022.09.007

2-Year Outcomes of Angiographic Quantitative Flow Ratio-Guided Coronary Interventions

J Am Coll Cardiol. 2022 Nov 29;80(22):2089-2101. doi: 10.1016/j.jacc.2022.09.007. Epub 2022 Sep 19.

Authors

Lei Song¹, Bo Xu², Shengxian Tu³, Changdong Guan¹, Zening Jin⁴, Bo Yu⁵, Guosheng Fu⁶, Yujie Zhou⁷, Jian'an Wang⁸, Yundai Chen⁹, Jun Pu¹⁰, Lianglong Chen¹¹, Xinkai Qu¹², Junqing Yang¹³, Xuebo Liu¹⁴, Lijun Guo¹⁵, Chengxing Shen¹⁶, Yaojun Zhang¹⁷, Qi Zhang¹⁸, Hongwei Pan¹⁹, Rui Zhang¹, Jian Liu²⁰, Yanyan Zhao²¹, Yang Wang²¹, Kefei Dou¹, Ajay J Kirtane²², Yongjian Wu¹, William Wijns²³, Weixian Yang¹, Martin B Leon²², Shubin Qiao²⁴, Gregg W Stone²⁵; FAVOR III China Study Group

Affiliations

¹ Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, Guangdong Province, China. Electronic address: https://twitter.com/BoXu86200483.
³ Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. Electronic address: sxtu@sjtu.edu.cn.
⁴ Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁵ Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
⁶ Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
⁷ Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
⁸ Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
⁹ Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China.
¹⁰ Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
¹¹ Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
¹² Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
¹³ Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China.
¹⁴ Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
¹⁵ Department of Cardiology, Peking University Third Hospital, Beijing, China.
¹⁶ Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
¹⁷ Department of Cardiology, Xuzhou Third People's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu Province, China.
¹⁸ Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
¹⁹ Department of Cardiology, Hunan Provincial People's Hospital, The First-Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, China.
²⁰ Department of Cardiology, Peking University People's Hospital, Beijing, China.
²¹ Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China.
²² Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA, and the Cardiovascular Research Foundation, New York, New York, USA.
²³ The Lambe Institute for Translational Medicine and CURAM, National University of Ireland Galway, Galway, Ireland.
²⁴ Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: qsbfw@sina.com.
²⁵ The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

PMID: 36424680
DOI: 10.1016/j.jacc.2022.09.007

Abstract

Background: In the multicenter, randomized, sham-controlled FAVOR (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) III China trial, quantitative flow ratio (QFR)-based lesion selection improved 1-year clinical outcomes compared with conventional angiographic guidance for percutaneous coronary intervention (PCI).

Objectives: The purpose of this study was to determine whether the benefits of QFR guidance persist at 2 years, particularly for patients in whom QFR changed the revascularization strategy.

Methods: Eligible patients were randomized to a QFR-guided strategy (PCI performed only if QFR ≤0.80) or a standard angiography-guided strategy. Major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), or ischemia-driven revascularization occurring within 2 years were analyzed in the intention-to-treat population.

Results: Among 3,825 randomized participants, 2-year MACE occurred in 161 of 1,913 (8.5%) patients in the QFR-guided group and in 237 of 1,912 (12.5%) patients in the angiography-guided group (HR: 0.66; 95% CI: 0.54-0.81; P < 0.0001), driven by fewer MIs (4.0% vs 6.8%; HR: 0.58; 95% CI: 0.44-0.77; P = 0.0002) and ischemia-driven revascularizations (4.2% vs 5.8%; HR: 0.71; 95% CI: 0.53-0.95; P = 0.02) in the QFR-guided group. Landmark analysis showed consistent results within the first year and between 1-2 years (P_int = 0.99). Although the 2-year MACE rate was lower in the QFR-guided group in both patients with and without revascularization strategy changes, the extent of outcome improvement was greater (P_int = 0.009) among those patients in whom the preplanned PCI strategy was modified by QFR.

Conclusions: QFR-guided lesion selection improved 2-year clinical outcomes compared with standard angiography guidance. The benefits were most pronounced among patients in whom QFR assessment altered the planned revascularization strategy. (FAVOR III China Study [The Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease] NCT03656848).

Keywords: angiography; coronary artery disease; percutaneous coronary intervention; quantitative flow ratio.

Publication types

Randomized Controlled Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Angiography
Coronary Artery Disease* / diagnostic imaging
Coronary Artery Disease* / surgery
Heart
Humans
Myocardial Infarction*
Percutaneous Coronary Intervention*

Associated data

ClinicalTrials.gov/NCT03656848