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.
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.
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.
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