The therapeutic value of the quantitative flow ratio (QFR), a new angiography-based metric for the functional evaluation of coronary stenoses, has recently been proven in patients receiving the percutaneous coronary intervention (PCI). For a study, researchers sought to determine if diabetes status impacts the positive outcomes of QFR advice for lesion selection during PCI.

The FAVOR III China trial substudy examined the clinical results of QFR-guided vs. angiography-guided PCI lesion selection according to the presence of diabetes. Diabetes was one of the prespecified variables for stratified randomization in the trial. The major adverse cardiac events (MACE) risk at one year was the primary outcome (a composite of all-cause death, myocardial infarction, or ischemia-driven revascularization).

A total of 1,295 (33.9%) of the 3,825 patients who were recruited had diabetes, and 347 (26.2%) of them were receiving insulin therapy. In diabetic and nondiabetic individuals, baseline characteristics were evenly distributed between treatment arms. The QFR-guided method similarly decreased the incidence of 1-year MACE compared to routine angiography-based lesion selection in diabetic patients (6.2% vs. 9.6%; HR: 0.64; 95% CI: 0.43-0.95) and nondiabetic patients (5.6% vs. 8.3%; HR: 0.66; 95% CI: 0.49-0.89) (Pinteraction = 0.88). Patients with and without diabetes had the same incidence of 1-year MACE (4.5% vs. 6.2%; P = 0.51) among patients with PCI postponed after QFR.

When compared to conventional angiography guidance, a QFR-guided lesion selection technique led to better PCI results in patients with and without diabetes.

Reference: jacc.org/doi/10.1016/j.jacc.2022.06.044