Cardiology · 2 h ago
QFR-Guided PCI Linked to Lower Three-Year Events in Multivessel Disease
A prespecified secondary analysis of the randomized FAVOR III China trial included 3,825 patients undergoing PCI. At three years, major adverse cardiac events were less frequent with quantitative flow ratio (QFR)-guided than angiography-guided PCI in patients with multivessel disease, but the treatment effect did not differ significantly by multivessel-disease status.
- Three-year MACE was lower with QFR guidance in MVD patients.
- No significant treatment-effect interaction by MVD status.
- Analysis was a prespecified secondary analysis of a randomized trial.
This prespecified secondary analysis of the FAVOR III China randomized clinical trial compared QFR-guided with angiography-guided PCI by multivessel disease (MVD) status. The trial enrolled patients at 26 centers in China; the analysis included 3,825 participants, of whom 2,066 (54.0%) had MVD. MVD was defined as involvement of at least two epicardial vessels or the left main coronary artery. The outcome assessed was three-year major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), and ischemia-driven revascularization.
Among patients with MVD, MACE occurred in 12.1% of the QFR-guided group and 18.1% of the angiography-guided group (hazard ratio, 0.65; 95% CI, 0.52-0.81; P<.001). The difference was driven by lower rates of MI and revascularization. In patients without MVD, rates were 8.6% and 11.0%, respectively (hazard ratio, 0.77; 95% CI, 0.57-1.04; P=.09). The treatment-by-MVD interaction was not significant (P=.35).
The findings provide longer-term randomized evidence supporting QFR-guided PCI across MVD strata, but this subgroup analysis does not establish a different treatment effect according to MVD status. Further confirmation is warranted; the results alone do not establish a change in practice.
In practice
For adults undergoing PCI, this analysis found lower three-year MACE with QFR-guided versus angiography-guided PCI among those with multivessel disease. The corresponding difference in patients without multivessel disease was not statistically significant, but the treatment-by-disease-status interaction was also not significant, so the analysis does not show that benefit differs by MVD status. These are findings from a prespecified secondary analysis of one randomized trial; the authors say further confirmation is warranted, and the results alone do not establish a practice change.
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JAMA Network Open: Quantitative Flow Ratio– vs Angiography-Guided Percutaneous Coronary Intervention ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.