Outcomes of Functionally Complete vs Incomplete Revascularization: Insights From the FAVOR III China Trial

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Functional complete revascularization (FCR) post-percutaneous coronary intervention (PCI) is linked to better patient prognosis.
• Residual functional SYNTAX score (rFSS) using pressure wire fractional flow reserve (FFR) assesses FCR.

Purpose of the Study:

• To evaluate the rates and clinical significance of FCR assessed by quantitative flow ratio (QFR).
• To compare outcomes of QFR-guided versus angiography-guided PCI in patients achieving or not achieving FCR.

Main Methods:

• The FAVOR III China trial randomized patients to QFR-guided or angiography-guided PCI.
• A prespecified substudy analyzed major adverse cardiac events (MACE) based on post-PCI FCR (rFSS=0) determined by core laboratory QFR.

Main Results:

• 85.2% of patients achieved FCR, with higher rates in the QFR-guided group (88.1%) versus angiography-guided (82.2%).
• Patients with FCR had significantly lower 1-year MACE (5.1%) compared to functional incomplete revascularization (FIR) (19.7%).
• QFR guidance improved FCR likelihood and 1-year outcomes in both FCR and FIR groups.

Conclusions:

• Achieving FCR after PCI is associated with substantially reduced 1-year MACE.
• QFR-guided PCI enhances FCR achievement and improves clinical outcomes compared to angiography guidance.