AQCA Study: Pre-PCI Virtual QFR for Planning PCI vs. Conventional Angiography

Several studies have used physiological assessment after a percutaneous coronary intervention (PCI) to improve clinical outcomes. However, results are not entirely conclusive. The limitations of using these physiological assessment methods are the need for extra measurements with increased procedure time, more radiation, and more contrast, which in turn leads to higher costs. 

Estudio AQVA: QFR virtual previo a la ATC para planificar angioplastia coronaria vs angiografía convencional

To counteract these limitations, several authors have proposed the use of virtual quantitative flow reserve (QFR) prior to PCI to plan the best strategy, allowing for the simulation of different therapeutic strategies and their corresponding results.

The aim of this multicenter, randomized study was to evaluate whether QFR-guided PCI is superior to angiography-guided PCI for optimal post-PCI QFR outcomes.

The primary endpoint (PEP) was the proportion of vessels with a final post-CTA QFR <0.90. The secondary endpoint (SEP) was the post-PCO QFR value, procedure duration, use of a contrast agent, number of stents, and stent length. Another secondary endpoint was cardiovascular death, incidence of acute myocardial infarction, and ischemia-guided revascularization of the treated vessel.

The study enrolled 300 patients, of whom 151 were randomized to QFR-guided PCI and 148 to angiography-guided PCI. Mean patient age was 70 years, and most subjects were men. The most frequent clinical presentation was chronic stable angina, followed by non-ST-segment elevation myocardial infarction (NSTEMI). The most treated artery was the anterior descending artery.

Read also: Deep Vein Arterialization: Have We Conquered “Non-Revascularizable” Critical Limb Ischemia?

The PEP was significantly more frequent in the angiography-guided PCI group, compared with the QFR-guided PCI group (p = 0.009). The main cause of suboptimal outcome in the angiography-guided group was underestimation of diseased segments outside the stents. There were no differences in the SEP in terms of procedure length, amount of contrast agent used, and radiation dose. However, the stent length and the number of stents were lower in the QFR-guided PCI group (p = 0.06; p = 0.08, respectively).

Conclusion

This study showed that QFR-guided PCI was superior to angiography-guided PCI to achieve an optimal physiological result after PCI, defined as post-PCI QFR ≥0.90. The QRF-based strategy changed operator planning in 25% of cases and was not linked to longer procedure times nor larger doses of contrast agent or radiation.

Dr. Andrés Rodríguez.
Member of the editorial board of SOLACI.org.

Original Title: QFR-Based Virtual PCI or Conventional Angiography to Guide PCI The AQVA Trial.

Reference: Simone Biscaglia, MD et al J Am Coll Cardiol Intv 2023.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

CRABBIS Trial: Comparison of Different Provisional Stenting Sequences

Provisional stenting (PS) is the gold standard for percutaneous coronary intervention (PCI) in most patients with coronary bifurcation lesions (CBL). Moreover, recent studies such...

Andromeda Trial: Meta-Analysis of Drug Coated Balloon vs. DES in Small Vessel DeNovo Lesions

The use of coronary stents vs plain old balloon angioplasty (POBA), has allowed to reduce recoil and limiting flow dissection which were major limitation...

QFR vs. FFR: Is Coronary Revascularization Deferral Safe? Results from a FAVOR III Sub-Analysis

In cases of intermediate coronary lesions, functional assessment is recommended to aid the decision-making process regarding revascularization. There are several tools currently used to...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...