Angiographic Quantitative Flow Ratio–Guided Treatment of Patients With Physiologically Intermediate Coronary Lesions
Background The FAVOR III (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients With Coronary Artery Disease) China trial reported improved clinical outcomes with percutaneous coronary intervention guided by quantitative flow ratio (QFR) compared w...
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Wiley
2025-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.035756 |
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| author | Jiannan Dai Changdong Guan Xueming Xu Jingbo Hou Haibo Jia Huai Yu Zening Jin Guosheng Fu Xiaofan Wu Liansheng Wang Rongchong Huang Zhujun Shen Yanyan Zhao Yuanzhe Jin Lei Song Shengxian Tu Shubin Qiao Bo Yu Bo Xu Gregg W. Stone |
| author_facet | Jiannan Dai Changdong Guan Xueming Xu Jingbo Hou Haibo Jia Huai Yu Zening Jin Guosheng Fu Xiaofan Wu Liansheng Wang Rongchong Huang Zhujun Shen Yanyan Zhao Yuanzhe Jin Lei Song Shengxian Tu Shubin Qiao Bo Yu Bo Xu Gregg W. Stone |
| author_sort | Jiannan Dai |
| collection | DOAJ |
| description | Background The FAVOR III (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients With Coronary Artery Disease) China trial reported improved clinical outcomes with percutaneous coronary intervention guided by quantitative flow ratio (QFR) compared with angiography. Whether these benefits also apply for patients presenting with “uncertainty‐zone” lesions of intermediate physiological significance is uncertain. This study aims to examine the impact of QFR guidance versus angiography guidance on the management and outcomes of percutaneous coronary intervention in uncertainty‐zone lesions. Methods and Results In this prespecified subgroup analysis, offline QFR assessment categorized 873 patients (22.9%) into the uncertainty‐zone subgroup, defined as having an offline QFR of 0.75 to 0.85 in all coronary arteries with a lesion causing ≥50% diameter stenosis. At 2 years, the rate of major adverse cardiac events, a composite of all‐cause death, myocardial infarction, or ischemia‐driven revascularization, occurred in 31 patients (7.0%) in the QFR‐guided group and 35 patients (8.3%) in the angiography‐guided group (hazard ratio [HR], 0.85 [95% CI, 0.52–1.37]). In landmark analysis, the relative treatment effect of QFR guidance versus angiography guidance on major adverse cardiac events differed before 1 year (4.7% versus 3.8%; HR, 1.25 [95% CI, 0.65–2.40]) and after 1 year (2.3% versus 5.5%; HR, 0.41 [95% CI, 0.20–0.87]) (Pinteraction=0.03), driven by fewer nonprocedural myocardial infarctions and ischemia‐driven revascularizations in the QFR‐guided group after 1‐year follow‐up. Conclusions In the modest‐sized subgroup of patients with physiologically intermediate lesions randomized in the FAVOR III China trial, 2‐year clinical outcomes were not significantly improved with a QFR‐guided revascularization strategy compared with angiography guidance. Registration URL: https://www.clinicaltrials.gov; Identifier: NCT 03656848. |
| format | Article |
| id | doaj-art-a1237c96d06d4f539f82499760793fef |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-a1237c96d06d4f539f82499760793fef2025-08-20T03:07:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-04-0114710.1161/JAHA.124.035756Angiographic Quantitative Flow Ratio–Guided Treatment of Patients With Physiologically Intermediate Coronary LesionsJiannan Dai0Changdong Guan1Xueming Xu2Jingbo Hou3Haibo Jia4Huai Yu5Zening Jin6Guosheng Fu7Xiaofan Wu8Liansheng Wang9Rongchong Huang10Zhujun Shen11Yanyan Zhao12Yuanzhe Jin13Lei Song14Shengxian Tu15Shubin Qiao16Bo Yu17Bo Xu18Gregg W. Stone19Department of Cardiology The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province ChinaThe Key Laboratory of Myocardial Ischemia Chinese Ministry of Education Harbin Heilongjiang Province ChinaDepartment of Cardiology The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province ChinaDepartment of Cardiology The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province ChinaDepartment of Cardiology The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province ChinaDepartment of Cardiology The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province ChinaDepartment of Cardiology Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Cardiology Sir Run Run Shaw Hospital Zhejiang University School of Medicine Hangzhou Zhejiang Province ChinaDepartment of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing ChinaDepartment of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing ChinaDepartment of Cardiology Beijing Friendship Hospital Capital Medical University Beijing ChinaDepartment of Cardiology Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaMedical Research and Biometrics Center National Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology The Fourth Affiliated Hospital of China Medical University Shenyang ChinaThe Key Laboratory of Myocardial Ischemia Chinese Ministry of Education Harbin Heilongjiang Province ChinaBiomedical Instrument Institute School of Biomedical Engineering Shanghai Jiao Tong University Shanghai ChinaThe Key Laboratory of Myocardial Ischemia Chinese Ministry of Education Harbin Heilongjiang Province ChinaDepartment of Cardiology The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province ChinaThe Key Laboratory of Myocardial Ischemia Chinese Ministry of Education Harbin Heilongjiang Province ChinaThe Zena and Michael A Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY USABackground The FAVOR III (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients With Coronary Artery Disease) China trial reported improved clinical outcomes with percutaneous coronary intervention guided by quantitative flow ratio (QFR) compared with angiography. Whether these benefits also apply for patients presenting with “uncertainty‐zone” lesions of intermediate physiological significance is uncertain. This study aims to examine the impact of QFR guidance versus angiography guidance on the management and outcomes of percutaneous coronary intervention in uncertainty‐zone lesions. Methods and Results In this prespecified subgroup analysis, offline QFR assessment categorized 873 patients (22.9%) into the uncertainty‐zone subgroup, defined as having an offline QFR of 0.75 to 0.85 in all coronary arteries with a lesion causing ≥50% diameter stenosis. At 2 years, the rate of major adverse cardiac events, a composite of all‐cause death, myocardial infarction, or ischemia‐driven revascularization, occurred in 31 patients (7.0%) in the QFR‐guided group and 35 patients (8.3%) in the angiography‐guided group (hazard ratio [HR], 0.85 [95% CI, 0.52–1.37]). In landmark analysis, the relative treatment effect of QFR guidance versus angiography guidance on major adverse cardiac events differed before 1 year (4.7% versus 3.8%; HR, 1.25 [95% CI, 0.65–2.40]) and after 1 year (2.3% versus 5.5%; HR, 0.41 [95% CI, 0.20–0.87]) (Pinteraction=0.03), driven by fewer nonprocedural myocardial infarctions and ischemia‐driven revascularizations in the QFR‐guided group after 1‐year follow‐up. Conclusions In the modest‐sized subgroup of patients with physiologically intermediate lesions randomized in the FAVOR III China trial, 2‐year clinical outcomes were not significantly improved with a QFR‐guided revascularization strategy compared with angiography guidance. Registration URL: https://www.clinicaltrials.gov; Identifier: NCT 03656848.https://www.ahajournals.org/doi/10.1161/JAHA.124.035756“uncertainty‐zone” lesionsmajor adverse cardiac eventspercutaneous coronary interventionquantitative flow ratio |
| spellingShingle | Jiannan Dai Changdong Guan Xueming Xu Jingbo Hou Haibo Jia Huai Yu Zening Jin Guosheng Fu Xiaofan Wu Liansheng Wang Rongchong Huang Zhujun Shen Yanyan Zhao Yuanzhe Jin Lei Song Shengxian Tu Shubin Qiao Bo Yu Bo Xu Gregg W. Stone Angiographic Quantitative Flow Ratio–Guided Treatment of Patients With Physiologically Intermediate Coronary Lesions Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease “uncertainty‐zone” lesions major adverse cardiac events percutaneous coronary intervention quantitative flow ratio |
| title | Angiographic Quantitative Flow Ratio–Guided Treatment of Patients With Physiologically Intermediate Coronary Lesions |
| title_full | Angiographic Quantitative Flow Ratio–Guided Treatment of Patients With Physiologically Intermediate Coronary Lesions |
| title_fullStr | Angiographic Quantitative Flow Ratio–Guided Treatment of Patients With Physiologically Intermediate Coronary Lesions |
| title_full_unstemmed | Angiographic Quantitative Flow Ratio–Guided Treatment of Patients With Physiologically Intermediate Coronary Lesions |
| title_short | Angiographic Quantitative Flow Ratio–Guided Treatment of Patients With Physiologically Intermediate Coronary Lesions |
| title_sort | angiographic quantitative flow ratio guided treatment of patients with physiologically intermediate coronary lesions |
| topic | “uncertainty‐zone” lesions major adverse cardiac events percutaneous coronary intervention quantitative flow ratio |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.035756 |
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