Visual-physiological concordance and target vessel outcomes: a μQFR-based real-world cohort study

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Quantitative flow ratio (QFR) is a non-interventional method for assessing coronary ischemia.
• The concordance of QFR-based assessments with real-world treatment decisions and clinical outcomes requires further investigation.

Purpose of the Study:

• To evaluate the alignment between Murray law-based QFR (μQFR) and treatment strategies for intermediate coronary stenosis.
• To assess the association between μQFR-treatment concordance and clinical outcomes, specifically target vessel failure (TVF).
• To identify factors influencing treatment decisions in relation to μQFR values.

Main Methods:

• Retrospective cohort study of 242 patients with intermediate coronary stenosis and μQFR values near the grey-zone.
• Treatment concordance defined as PCI for low μQFR and medication for high μQFR.
• Kaplan-Meier analysis for TVF (cardiac death, MI, ID-TVR) and logistic regression for decision determinants over 18 months median follow-up.

Main Results:

• Treatment was discordant with μQFR in 26.9% of patients.
• μQFR-concordant treatment was associated with significantly lower TVF (2.3% vs. 7.9%, P=0.043), mainly due to reduced ischemia-driven target vessel revascularization (ID-TVR).
• Lesion severity and coronary complexity influenced operator decisions, with more severe lesions favoring PCI and higher complexity favoring conservative management.

Conclusions:

• A significant proportion of treatments for intermediate coronary stenoses were discordant with μQFR assessments.
• μQFR-concordant treatment strategies are linked to improved clinical outcomes, specifically reduced TVF and ID-TVR.
• Integrating μQFR into clinical practice may optimize revascularization decisions and enhance patient outcomes.