FFR angiography-guided lesion selection for PCI improves two-year outcomes in late onset TST

Among the 3,825 randomized participants, two-year major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), or ischemia-induced revascularization (IDR), occurred in 8.5% of patients in the QFR-guided test compared to 12.5% ​​of patients in the angiography-guided group (HR 0.66, 95% CI 0.54-0.81, p

Compared to the selection of target lesions before randomization based on guided angiography, the revascularization strategy was modified after randomization in 445 (23.3%) patients in the QFR-guided group and 119 (6.2%) in the angiography-guided group (P

Although the two-year MACE rate was lower with QFR counseling in the two patients in whom the pre-planned PCI revascularization strategy changed (HR 0.34, 95% CI 0.21-0.55 ) and did not change (HR 0.70, 95% CI 0.56-0.88) after randomization, those who changed strategy had a greater relative reduction in MACE (pint = 0.009), thanks to better results in patients in whom the vessels that needed to be treated were deferred after QFR assessment. Patients with pre-PCI QFR-concordant versus non-concordant treatment had a lower risk of MACE at two years (8.8% vs. 17.2%, P

The benefit of matching QFR treatment was present in patients randomized to QFR guidance and angiographic guidance.

The study received a grant from the National Cardiovascular Disease Clinical Research Center, Fuwai Hospital (Grant No. NCRC2020001), Beijing Municipal Commission of Science and Technology (Grant No. Z191100006619107), and the National High Level Hospital Clinical Research Funding (Grant Number: 2022-GSP-GG-20). Pulse Medical (Shanghai, China) provided the QFR system and software for the study free of charge.

Martin E. Berry