Angiographic Quantitative Flow Ratio-Guided Treatment of Patients With Physiologically Intermediate Coronary Lesions.

IF 5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Heart Association Pub Date : 2025-04-01 Epub Date: 2025-03-21 DOI:10.1161/JAHA.124.035756

Jiannan Dai, Changdong Guan, Xueming Xu, Jingbo Hou, Haibo Jia, Huai Yu, Zening Jin, Guosheng Fu, Xiaofan Wu, Liansheng Wang, Rongchong Huang, Zhujun Shen, Yanyan Zhao, Yuanzhe Jin, Lei Song, Shengxian Tu, Shubin Qiao, Bo Yu, Bo Xu, Gregg W Stone

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引用次数: 0

Abstract

Background: The FAVOR III (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients With Coronary Artery Disease) China trial reported improved clinical outcomes with percutaneous coronary intervention guided by quantitative flow ratio (QFR) compared with angiography. Whether these benefits also apply for patients presenting with "uncertainty-zone" lesions of intermediate physiological significance is uncertain. This study aims to examine the impact of QFR guidance versus angiography guidance on the management and outcomes of percutaneous coronary intervention in uncertainty-zone lesions.

Methods and results: In this prespecified subgroup analysis, offline QFR assessment categorized 873 patients (22.9%) into the uncertainty-zone subgroup, defined as having an offline QFR of 0.75 to 0.85 in all coronary arteries with a lesion causing ≥50% diameter stenosis. At 2 years, the rate of major adverse cardiac events, a composite of all-cause death, myocardial infarction, or ischemia-driven revascularization, occurred in 31 patients (7.0%) in the QFR-guided group and 35 patients (8.3%) in the angiography-guided group (hazard ratio [HR], 0.85 [95% CI, 0.52-1.37]). In landmark analysis, the relative treatment effect of QFR guidance versus angiography guidance on major adverse cardiac events differed before 1 year (4.7% versus 3.8%; HR, 1.25 [95% CI, 0.65-2.40]) and after 1 year (2.3% versus 5.5%; HR, 0.41 [95% CI, 0.20-0.87]) (P_interaction=0.03), driven by fewer nonprocedural myocardial infarctions and ischemia-driven revascularizations in the QFR-guided group after 1-year follow-up.

Conclusions: In the modest-sized subgroup of patients with physiologically intermediate lesions randomized in the FAVOR III China trial, 2-year clinical outcomes were not significantly improved with a QFR-guided revascularization strategy compared with angiography guidance.

Registration: URL: https://www.clinicaltrials.gov; Identifier: NCT03656848.

查看原文本刊更多论文

血管造影定量血流比率引导治疗生理性中度冠状动脉病变。

背景：中国的FAVOR III（定量血流比引导和血管造影引导下冠状动脉疾病患者经皮介入治疗的比较）试验报告了定量血流比（QFR）引导下的经皮冠状动脉介入治疗与血管造影相比改善了临床结果。这些益处是否也适用于具有中等生理意义的“不确定区”病变的患者尚不确定。本研究旨在探讨QFR指导与血管造影指导对不确定区病变经皮冠状动脉介入治疗的处理和结果的影响。方法和结果：在这个预先指定的亚组分析中，离线QFR评估将873例（22.9%）患者分类为不确定区亚组，定义为所有冠状动脉病变导致≥50%直径狭窄的离线QFR为0.75至0.85。2年后，qfr引导组的31名患者（7.0%）和血管造影引导组的35名患者（8.3%）发生了主要心脏不良事件（全因死亡、心肌梗死或缺血驱动的血运重建）（风险比[HR]， 0.85 [95% CI, 0.52-1.37]）。在里程碑式分析中，1年前QFR指导与血管造影指导对主要心脏不良事件的相对治疗效果存在差异(4.7% vs 3.8%；HR, 1.25 [95% CI, 0.65-2.40])和1年后(2.3%对5.5%；HR, 0.41 [95% CI, 0.20-0.87]) (p - interaction=0.03)，在1年随访后，qfr引导组的非程序性心肌梗死和缺血驱动的血运重建较少。结论：在中国FAVOR III试验中随机分配的中等大小的生理中度病变患者亚组中，与血管造影术指导相比，qfr引导下的血运重建术2年临床结果没有显著改善。注册：网址：https://www.clinicaltrials.gov；标识符:NCT03656848。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Heart Association CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

1.90%

发文量

1749

审稿时长

12 weeks

期刊介绍： As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice. JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.