2-Year Outcomes of Angiographic Quantitative Flow Ratio-Guided Coronary Interventions

作者：Song, Lei; Xu, Bo; Tu, Shengxian^*; Guan, Changdong; Jin, Zening; Yu, Bo; Fu, Guosheng; Zhou, Yujie; Wang, Jian'an; Chen, Yundai; Pu, Jun; Chen, Lianglong; Qu, Xinkai; Yang, Junqing; Liu, Xuebo; Guo, Lijun; Shen, Chengxing; Zhang, Yaojun; Zhang, Qi; Pan, Hongwei; Zhang, Rui; Liu, Jian; Zhao, Yanyan; Wang, Yang; Dou, Kefei; Kirtane, Ajay J.; Wu, Yongjian; Wijns, William; Yang, Weixian; Leon, Martin B.; Qiao, Shubin^*; Stone, Gregg W.

来源：Journal of the American College of Cardiology, 2022, 80(22): 2089-2101.

DOI：10.1016/j.jacc.2022.09.007

• angiography
• coronary artery disease
• percutaneous coronary intervention
• quantitative flow ratio

BACKGROUND In the multicenter, randomized, sham-controlled FAVOR (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) III China trial, quantitative flow ratio (QFR)-based lesion selection improved 1-year clinical outcomes compared with conventional angiographic guidance for percutaneous coronary intervention (PCI).OBJECTIVES The purpose of this study was to determine whether the benefits of QFR guidance persist at 2 years, particularly for patients in whom QFR changed the revascularization strategy. METHODS Eligible patients were randomized to a QFR-guided strategy (PCI performed only if QFR #0.80) or a stan-dard angiography-guided strategy. Major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), or ischemia-driven revascularization occurring within 2 years were analyzed in the intention-to-treat population.RESULTS Among 3,825 randomized participants, 2-year MACE occurred in 161 of 1,913 (8.5%) patients in the QFR-guided group and in 237 of 1,912 (12.5%) patients in the angiography-guided group (HR: 0.66; 95% CI: 0.54-0.81; P < 0.0001), driven by fewer MIs (4.0% vs 6.8%; HR: 0.58; 95% CI: 0.44-0.77; P = 0.0002) and ischemia-driven revascularizations (4.2% vs 5.8%; HR: 0.71; 95% CI: 0.53-0.95; P = 0.02) in the QFR-guided group. Landmark analysis showed consistent results within the first year and between 1-2 years (Pint = 0.99). Although the 2-year MACE rate was lower in the QFR-guided group in both patients with and without revascularization strategy changes, the extent of outcome improvement was greater (Pint = 0.009) among those patients in whom the preplanned PCI strategy was modified by QFR.CONCLUSIONS QFR-guided lesion selection improved 2-year clinical outcomes compared with standard angiography guidance. The benefits were most pronounced among patients in whom QFR assessment altered the planned revascu-larization strategy. (FAVOR III China Study [The Comparison of Quantitative Flow Ratio Guided

• 单位
  6; 浙江大学; 复旦大学; 中国医学科学院; 哈尔滨医科大学; 广东省人民医院; 北京大学; 上海交通大学; 同济大学