The Look Inside in the Benefit of Physiology-Guided Revascularization: From Diagnostic Value to Prognostic Implication of Quantitative Flow Ratio (QFR)
Presenter
Dr. Hao-Yu Wang, MD, PhD, FSCAI, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, BC, China
Dr. Hao-Yu Wang, MD, PhD, FSCAI, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, BC, China and Kefei Dou, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
Keywords: Imaging & Physiology and Stable Ischemic Heart Disease (SIHD)
Background:
We aimed to look inside in the benefit of physiology-guided revascularization from the diagnostic value to prognostic implication of quantitative flow ratio (QFR).
Methods:
In FAVOR III China trial, operators were required to declare all target vessels intended for PCI (pre-randomization declared treatment plan) before randomization. After randomization, the actual treatment strategy was performed with online QFR or angiography guidance (randomized allocation). In this study, pre-randomization treatment plan and post-randomization treatment strategy was adjudicated with offline QFR by independent Corelab for defining the physiological concordances.
Results:
Among 3,768 patients with available offline QFR, 1,167 (31.0%) of patients had pre-randomization physiology-concordant plan, primary 2-year MACE rates were 7.6% in patients assigned to QFR-guided group compared to 17.0% in those assigned to angiography-guided group in whom pre-randomization nonconcordant plan was observed (HR 0.43, 95% CI: 0.30-0.61), and in 8.9% vs. 10.4% respectively among patients with an pre-randomization concordant plan (HR 0.85 [0.66-1.09]), indicating a significant interaction (P = 0.002).
Patients with older age, multivessel disease, LCX or RCA involved, and lower SYNTAX score were found more likely to have pre-randomization physiology-nonconcordant. Physiological concordances were reclassified in 447 (23.6%) and 87 (4.6%) patients with online QFR or angiography guidance, in which a significant between-groups difference was identified in terms of achieving post-randomization physiology-concordant (92.3% vs. 67.2%). Patients with vs. those without post-randomization physiology-concordant strategy had lower risk of 2-year MACE (8.8% vs. 17.2%; HR 0.49 [0.40-0.60]).
Conclusions
:
Compared with angiography-guided group, physiological concordances were more likely to be reclassified in online QFR-guided group with greater likelihood of achieving post-randomization physiology-concordant; Patients with post-randomization physiology-concordant had significantly lower risk of 2-year MACE compared with post-randomization physiology-nonconcordant (either inappropriate treatment or deferral).