Pre-PCI: QFR helps in PCI planning

In the AQVA trial, Simone Biscaglia and co-authors aimed to compare the effectiveness of quantitative flow ratio (QFR)-based virtual percutaneous coronary intervention (PCI) against conventional angiography-based PCI in achieving optimal post-PCI QFR results. This investigator-initiated, randomized, controlled, parallel-group clinical trial involved 300 patients undergoing PCI, with the primary outcome being the rate of study vessels with suboptimal post-PCI QFR values (<0.90). Results showed that the angiography-based PCI group had a significantly higher occurrence of suboptimal outcomes compared to the QFR-based virtual PCI group. The main reason for suboptimal outcomes in the angiography-based group was the underestimation of diseased segments outside the stented area. While there were no significant differences in secondary endpoints, such as procedure duration and stent characteristics, the trial highlighted the superiority of QFR-based virtual PCI in achieving optimal physiological results post-PCI. The main results can be summarized as follows: 1) QFR-based virtual PCI is superior to conventional angiography-based PCI at achieving optimal post-PCI physiology results 2) QFR-based virtual PCI affects the procedural plan in more than one-quarter of patients 3) QFR-based virtual PCI application did not significantly increase procedural time, contrast dye, or x-ray use.