Rationales Behind Physiology-Guided Revascularization: Diagnostic Impact of Quantitative Flow Ratio in the FAVOR III China Trial
Authors' conclusion
In the FAVOR III China trial, approximately 30% of patients showed discrepancies between angiography-based treatment plans and physiological ischemia. The mechanistic insight underlying the benefits of QFR-guided PCI is reclassification following online QFR guidance, which leads to a shift from initially flawed plans toward physiology-concordant decisions.
Study context
- Population
- Patients undergoing percutaneous coronary intervention (PCI) in the FAVOR III China trial with available off-line quantitative flow ratio (QFR)pooled, with off-line QFR
- Participants
- 3,768 patients
- Comparison
- Online QFR-guided vs angiography-guided PCI
- QFR-guidedn = 1,891
- Angiography-guidedn = 1,877reference
- Primary endpoint
- Major adverse cardiac events
Methodological detailsmulticenter, core laboratory off-line QFR adjudication
- Multicenter
- Core laboratory off-line QFR adjudication
Primary result
As reported in the abstract
Significant interaction between prerandomization physiological concordance and randomized allocation
P for interaction = 0.002
Further findings
Prerandomization physiology-concordant plans
standardized mean difference 0.087
Reclassification of physiological concordance
Postrandomization physiological concordance
standardized mean difference 0.665
- Prerandomization physiology-concordant plans — Overall prerandomization physiology-concordant plans
- 2,601 (69.0%)
Predictors of prerandomization physiological nonconcordance
- Older age, multivessel disease, left circumflex or right coronary artery involved, and lower SYNTAX scores more likely nonconcordant
Original publication
Summarised from the published abstract; every number is checked against it