1. 2-Year Outcomes of Angiographic Quantitative Flow Ratio-Guided Coronary Interventions.
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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, and Pan, Hongwei
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ANGIOGRAPHY , *PERCUTANEOUS coronary intervention , *CORONARY artery disease , *MYOCARDIAL infarction , *EVALUATION research , *MEDICAL care , *HEART , *RANDOMIZED controlled trials , *RESEARCH , *RESEARCH methodology , *COMPARATIVE studies , *CARDIOVASCULAR system - Abstract
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 standard 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 revascularization strategy. (FAVOR III China Study [The Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease] NCT03656848). [ABSTRACT FROM AUTHOR]- Published
- 2022
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