Coronary revascularisation deferral based on quantitative flow ratio or fractional flow reserve: a post hoc analysis of the FAVOR III Europe trial.

IF 7.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Eurointervention Pub Date : 2025-02-03 DOI:10.4244/EIJ-D-24-01001
Birgitte K Andersen, Niels R Holm, Lone J H Mogensen, Luc Maillard, Truls Råmunddal, Andrea Erriquez, Evald H Christiansen, Javier Escaned, On Behalf Of The Favor Iii Europe Study Team
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Abstract

Background: Safe deferral of revascularisation is a key aspect of physiology-guided percutaneous coronary intervention (PCI). While recent evidence gathered in the FAVOR III Europe trial showed that quantitative flow ratio (QFR) guidance did not meet non-inferiority to fractional flow reserve (FFR) guidance, it remains unknown if QFR might have a specific value in revascularisation deferral.

Aims: We aimed to evaluate the safety of coronary revascularisation deferral based on QFR as compared with FFR.

Methods: Patients randomised in the FAVOR III trial in whom PCI was deferred in at least one coronary artery, based on QFR or FFR>0.80, were included in the present substudy. The primary outcome was the 1-year rate of major adverse cardiac events (MACE), with results reported for two subsets of deferred patients: (1) any study lesion deferral and (2) complete study lesion deferral.

Results: A total of 523 patients (55.2%) in the QFR group and 599 patients (65.3%) in the FFR group had at least one coronary revascularisation deferral. Of these, 433 patients (82.8%) and 511 (85.3%) patients, respectively, had complete study lesion deferral. In the "complete study lesion deferral" patient group, the occurrence of MACE was significantly higher in QFR-deferred patients as compared with FFR-deferred patients (24 [5.6%] vs 14 [2.8%], adjusted hazard ratio [HR] 2.07, 95% confidence interval [CI]: 1.07-4.03; p=0.03). In the subgroup of "any study lesion deferral", the MACE rate was 5.6% vs 3.6% (QFR vs FFR), adjusted HR 1.55, 95% CI: 0.88-2.73; p=0.13.

Conclusions: QFR-based deferral of coronary artery revascularisation resulted in a higher incidence of 1-year MACE as compared with FFR-based deferral.

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基于定量血流比率或部分血流储备的冠状动脉血运重建延迟:对FAVOR III欧洲试验的事后分析。
背景:安全延迟血管重建是生理引导下经皮冠状动脉介入治疗(PCI)的一个关键方面。虽然最近在FAVOR III欧洲试验中收集的证据表明,定量血流比(QFR)指导不符合分数血流储备(FFR)指导的非效性,但QFR是否在血血重建延迟中具有特定价值仍不清楚。目的:我们的目的是评估基于QFR与FFR的冠状动脉血运延期的安全性。方法:根据QFR或FFR bb0 0.80,在FAVOR III试验中随机分组的至少一条冠状动脉延迟PCI的患者被纳入本亚研究。主要结局是1年主要心脏不良事件发生率(MACE),报告了两个延迟患者亚群的结果:(1)任何研究病变延迟和(2)完全研究病变延迟。结果:QFR组共有523例(55.2%)患者和FFR组599例(65.3%)患者至少有一次冠状动脉血运延期。其中,分别有433例(82.8%)和511例(85.3%)患者有完全的研究病变延迟。在“完全研究病变延迟”患者组中,qfr延迟患者的MACE发生率明显高于ffr延迟患者(24 [5.6%]vs 14[2.8%]),校正风险比[HR] 2.07, 95%可信区间[CI]: 1.07-4.03;p = 0.03)。在“任何研究病变延迟”亚组中,MACE率为5.6% vs 3.6% (QFR vs FFR),调整后危险度为1.55,95% CI: 0.88-2.73;p = 0.13。结论:与基于ffr的延迟相比,基于qfr的延迟冠状动脉血运重建导致1年MACE的发生率更高。
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来源期刊
Eurointervention
Eurointervention CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
4.80%
发文量
380
审稿时长
3-8 weeks
期刊介绍: EuroIntervention Journal is an international, English language, peer-reviewed journal whose aim is to create a community of high quality research and education in the field of percutaneous and surgical cardiovascular interventions.
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