Angiographic Quantitative Flow Ratio-Guided Coronary Intervention: 5-Year Follow-Up From the FAVOR III China...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• The FAVOR III China trial previously showed superior outcomes for quantitative flow ratio (QFR)-guided percutaneous coronary intervention (PCI) compared to angiography guidance at 1 and 2 years.
• Long-term sustainability of these QFR benefits remained undetermined.

Purpose of the Study:

• To assess the 5-year clinical effectiveness and safety of a QFR-guided PCI strategy versus traditional angiography-guided PCI.

Main Methods:

• A multicenter, randomized trial comparing QFR-guided PCI (intervention if QFR ≤0.80) with angiography-guided PCI.
• Inclusion criteria: patients with intermediate coronary lesions (50%-90% diameter stenosis) in vessels ≥2.5 mm.
• Primary endpoint: major adverse cardiac events (MACE) at 1 year; 5-year outcomes reported.

Main Results:

• At 5 years, QFR guidance significantly reduced MACE (17.5% vs 21.1%, HR 0.80, P=0.002).
• This reduction was driven by fewer myocardial infarctions and ischemia-driven revascularizations in the QFR group.
• Benefits of QFR guidance were predominantly observed within the first 2 years, with similar outcomes between 2 and 5 years.

Conclusions:

• QFR-guided PCI significantly improves 5-year clinical outcomes compared to angiography guidance.
• The primary benefits of QFR guidance are achieved within the initial 2 years following PCI.