QFR-guided lesion selection tied to better PCI outcomes than conventional angiography: FAVOR III China Trial

China: A QFR-guided strategy of lesion selection among patients undergoing percutaneous coronary intervention (PCI) improved clinical outcomes compared with standard angiography guidance, according to findings from FAVOR III China trial. Quantitative flow ratio (QFR) is a novel angiography-based approach to estimate the fractional flow reserve.

The findings of the study were presented at TCT 2021, the 33rd annual scientific symposium of the Cardiovascular Research Foundation (CRF) and subsequently published in The Lancet. 

Pressure wire-based physiological measurement is known to be more accurate in identifying flow-limiting lesions in patients with coronary artery disease compared with visual angiographic assessment. Despite this, angiography remains the most widely used method to guide PCI. In FAVOR III China trial, Bo Xu, Peking Union Medical College, Beijing, China, and colleagues aimed to establish whether clinical outcomes might be improved by lesion selection for PCI using the quantitative flow ratio (QFR), a novel angiography-based approach to estimate the fractional flow reserve.

FAVOR III China is multicentre, blinded, randomized, sham-controlled trial done at 26 hospitals in China. It included patients aged 18 years or older, with stable or unstable angina pectoris or patients who had a myocardial infarction at least 72 h before screening, who had at least one lesion with diameter stenosis of 50–90% in a coronary artery with a reference vessel of at least 2·5 mm diameter by visual assessment were eligible. 

Patients were randomly assigned to receive either a QFR-guided strategy (PCI performed only if QFR ≤0·80) or an angiography-guided strategy (PCI based on a standard visual angiographic assessment). 

The primary endpoint was the 1-year rate of major adverse cardiac events, a composite of death from any cause, myocardial infarction, or ischemia-driven revascularisation. The primary analysis was done in the intention-to-treat population. 

3847 patients were enrolled between Dec 25, 2018, and Jan 19, 2020. After exclusion of 22 patients who elected not to undergo PCI or who were withdrawn by their physicians, 3825 participants were included in the intention-to-treat population (1913 in the QFR-guided group and 1912 in the angiography-guided group).

Based on the study, the researchers found that the 1-year primary endpoint occurred in 110 (Kaplan-Meier estimated rate 5·8%) participants in the QFR-guided group and in 167 (8·8%) participants in the angiography-guided group (difference, –3·0%; hazard ratio 0·65), driven by fewer myocardial infarctions and ischemia-driven revascularisations in the QFR-guided group than in the angiography-guided group.

The researchers concluded that "among patients undergoing PCI, a QFR-guided strategy of lesion selection improved 1-year clinical outcomes compared with standard angiography guidance."

Reference:

The study titled, "Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial," is published in The Lancet. 

DOI: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02248-0/fulltext