The latest developments of Medis QFR® - February 2024

Reading time: 10 mins
Written on: February 29, 2024
Given the regular posts of peer-reviewed scientific publications on the Medis QFR®, it is clear that this angio-based solution for coronary physiology is extensively used in clinical research and practice. We would like to share these publications with you so that you remain up-to-date about the research that is ongoing worldwide with this innovative solution, whereby each time new clinical applications are being tested, validated, tried-out in particular populations. In this february edition of the Medis QFR® blog article we are proud to share five publications with you.

Diagnostic performance of nonhyperemic pressure ratios and coronary angiography-based fractional flow reserve against conventional wire-based fractional flow reserve.

Dr. W. Li from the Heart, Lung and Vascular Institute, Adventh Health in Orlando, Florida and co-authors from various US centers under the supervision of Dr. Y. Kobayashi from the New York-Presbyterian Brooklyn Hospital, published this very interesting review paper. The goal of this study was to compare the diagnostic accuracy of NHPR techniques and coronary angio-FFR against wire-based FFR. A total of 6693 records were identified after a literature search, including 37 reports for NHPRs (iFR, Pd/Pa, DPR and RFR) and 34 for angio-FFR (Cathworks, Medis and others). Overall, NHPRs have a lower diagnostic performance with an AuC= 0.85 when compared with angio-FFR (AuC=0.95). The four NHPRs had overlapping AuCs without major differences among each other; likewise, QFR and FFRangio had overlapping AuCs without major differences among each other. The authors conclude that angio-FFR may offer a better estimation of wire-based FFR than NHPRs. And also these result support a wider use of angio-FFR in the cardiac catheterization laboratory to streamline the workflow for coronary physiologic assessment.

Sex differences in clinical outcomes associated with Quantitative Flow Ratio-guided percutaneous coronary intervention.

Dr. Y. Chen from the PLA General Hospital in Beijing and co-authors from the FAVOR III China Study Group under the senior authorship of Dr. L. Song, from the National Clinical Research Center for Cardiovascular Diseases at Fuwai Hospital, also Beijing in China, published this interesting paper in JACC Asia. This work represents a subgroup analysis of the FAVOR III China trial, in which a total of 1126 women and 2699 men participated. Compared with an angiography-guided strategy, a QFR-guided strategy resulted in a 7.9% and 9.7% reduction in PCI rated in men and women, respectively. The QFR analyses were carried out off-line. The QFR-guided strategy resulted in similar relative risk reductions for 2-year MACE in women (8.0% vs 12.7%) and men (8.7% vs 12.4%). Furthermore, QFR values were not significantly different between men and women with various angiographic stenosis categories. The authors concluded that a QFR-guided PCI-strategy resulted in improved MACE in both men and women at 2 years compared with an angiography-guided PCI-strategy.

Quantitative flow ratio for the prediction of coronary events after percutaneous coronary intervention.

Dr. S. Kageyama and co-authors under the supervision of Prof. P.W. Serruys at the University of Galway in Ireland and on behalf of the Multivessel TALENT Trials investigators published this Research Correspondence in EuroIntervention. This is a vessel-based analysis using the post-PCI QFR in 1068 vessels from the first 775 patients randomized in the Multivessel TALENT Study to forecast the rate of VOCE at 2 years for the entire population. Favourable post-PCI results (QFR > 0.91) were obtained in 76% of the patients, resulted in an expected overall favourable VOCE rate of 6.1% with a boundary of 4.8% – 7.4%.

QFR assessment and prognosis after nonculprit PCI in patients with acute myocardial infarction.

Dr. S.H. Lee fron Chonnam National University Hospital in Gwangu published this very interesting paper under the supervison of Dr. J.M. Lee of Samsung Medical Center in Seoul, Korea on behalf of the FRAME-AMI investigators. This is a post hoc analysis of non-IRA lesions of AMI patients enrolled in the FRAME-AMI Study, which randomly allocated 562 patients into either FFR-guided PCI or angiography-guided PCI for non-IRA lesions. Patients were also classified by non-IRA values into QFR 0.80. A total of 443 patients (552 lesions) were eligible for QFR analysis. Of 209 patients in the angiography-guided group, 30% (n=60) underwent non-IRA PCI despite having QFR > 0.80 in the non-IRA. At a medium follow-up of 3.5 years, the rate of MACE was significantly higher among patients with non-IRA PCI despite QFR > 0.80 than in patients with deferred PCI for non-IRA lesions (12.9 % vs 3.1%). The authors concluded that in AMI patients with multi-vessel disease, 30% of angiography-guided PCI resulted in un-necessary PCI for the non-IRA with QFR > 0.80.

Prognostic role of discordance between quantitative flow ratio and visual estimation in revascularization guidance.

Dr. D. Terentes-Printzios and co-authors under the supervision of Dr. C. Vlachopoulos published this very interesting paper in the Eur. Heart J. Open. This is a retrospective study on all-comers undergoing coronary angiography. Vessels with QFR were divided into 4 groups based on the decision by visual interpretation to perform or defer PCI and the QFR results. Overall, 546 patients were included and discordance between QFR and visual interpretation was found in 16.2 % of patients. After a median FU of 2.5 years, the discordance group had significantly higher rate of composite outcome (hazard ratio 3.34) than the concordance group. The authors concluded that these results highlight the importance of proper patient selection for intervention and the need to avoid improper stent implantations when not dictated by a comprehensive functional assessment.

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