The following is a summary of “2-Year Outcomes of Angiographic Quantitative Flow Ratio-Guided Coronary Interventions” published in the November 2022 issue of Cardiology by Song et al.

Quantitative flow ratio (QFR)-based lesion selection for percutaneous coronary intervention (PCI) improved 1-year clinical outcomes 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 trial. For a study, researchers sought to ascertain if the advantages of QFR guidance continue to be beneficial at 2 years, particularly for patients in whom QFR altered the revascularization plan.

Patients who met the criteria were randomized to either a QFR-guided method (PCI was only conducted if QFR was≤ 0.80) or a conventional angiography-guided strategy. In the intention-to-treat population, major adverse cardiac events (MACE), a composite of all-cause mortality, myocardial infarction (MI), or ischemia-driven revascularization occurring within 2 years, were examined.

Two-year MACE occurred in 161 of 1,913 (8.5%) patients in the QFR-guided group and 237 of 1,912 (12.5%) patients in the angiography-guided group among 3,825 randomized participants (HR: 0.66; 95% CI: 0.54-0.81; P <0.0001). This difference was caused by the QFR-guided group’s lower rates of 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. According to the landmark analysis, the first year and the next two years produced consistent findings (Pint = 0.99). Although both patients with and without adjustments to the revascularization method had decreased 2-year MACE rates in the QFR-guided group, the amount of the outcome improvement was larger (Pint = 0.009) among patients in whom the preplanned PCI strategy was altered by QFR.

Compared to conventional angiography guidance, 2-year clinical outcomes were improved by QFR-guided lesion selection. Patients whose QFR assessment changed their planned revascularization strategy had the greatest benefits.

Reference: jacc.org/doi/10.1016/j.jacc.2022.09.007