The latest developments of Medis QFR® - April 2026

Home > The latest developments of Medis QFR® – April 2026

The latest developments of Medis QFR® - April 2026

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Written on: April 28, 2026

The past two weeks have shown a very clear momentum across the angio-derived physiology (ADP) field. (1) PIONEER IV  interim-analysis on the first 1270 patients confirmed that QFR is non‑inferior to the current standard of care, and safe to use; (2) The ACC presentations on the ALL-RISE trail and the Fast III trial made very clear that these results are very much in line with the results of the FAVOR III EU trial, in terms of MACE, relative number of interventions in the angio-arm relative to the wire-arm, etc. It also made clear that the MACE in the angio-arm of the FAVOR III EU is the lowest among these three trials. (3) The ARCH  Symposium in St. Louis  demonstrated how easily QFR can be integrated into routine clinical practice. Together, these developments point to a consistent direction – physiology‑guided (ADP) care is steadily moving toward standard clinical practice. As Editor‑in‑Chief, I have selected five recently published papers that contribute each in their own way towards the same theme: turning evidence into adoption through ease of use, with Medis QFR® positioned as the solution to make that transition possible.

Rationales behind physiology-guided revascularization. Diagnostic impact of Quantitative Flow Ratio in the FAVOR III China Trial.

Dr R Zhang as first author on behalf of the FAVOR III China Study Group published this very interesting paper in JACC Interventions. This is a very detailed post-hoc analysis of the FAVOR III China trial, which was an investigator-initiated blinded, randomized, sham-controlled, multi-center trial in 3825 patients, that examined 1- and 2-year clinical outcomes following PCI with a QFR-guided lesion selection strategy versus standard angiographic guidance. In this post-hoc analysis, the pre-randomization treatment plan and post-randomization treatment strategy were adjudicated using off-line QFR by an independent core laboratory to determine physiological concordance. The results can be summarized as follows: 1) a pre-randomization plan based on angiography was discordant with a physiology-based plan in nearly one-third of patients; 2) among patients with nonconcordant plans, 2-year MACE rates were significantly lower in the QFR-guided group compared with the angiography-guided group (7.6% vs 17.0%), whereas no significant differences were observed among those with concordant plans (8.9% vs 10.4%); and 3) both inappropriate treatment and inappropriate deferral were associated with adverse outcomes; however, inappropriate deferral appeared to have a more pronounced impact on prognosis. The authors conclude, that the benefits of QFR-guided PCI are reclassification following online QFR guidance, which leads to a shift from initially flawed plans toward physiology-concordant decisions.

Diagnostic relevance of angiography-derived coronary microcirculatory resistance in sudden cardiac death.

Dr B Sedoud from the University Hospital in Grenoble, France and co-authors under the leadership of Prof G Barone-Rochette published this interesting paper in Quantitative Imaging and Medical Surgery. This was a retrospective study in 30 patients who survived from sudden cardiac death (SCD) with no significant lesions on coronary angiography. Patients were divided into two groups, Group 1 with myocardial disease (N=20); and Group 2 without myocardial disease (N=10), with myocardial disease based on magnetic resonance imaging (CMR). Non-hyperemic-IMR was based on Medis QFR V2.1.; frame speed was 15 f/s. Group 1 presented a significantly higher NH-IMR compared to Group 2 (46.5 vs 34.1). An NH-IMRangio cut-off of 41.5 enabled an optimal classification of patients with and without myocardial disease. The authors concluded that a high NH-IMRangio could represent a useful tool for guiding the etiological diagnosis of SCD towards myocardial disease rather than electrical heart disease.

Impact of coronary artery disease patterns assessed with pullback pressure gradient on clinical outcomes: Meta-analysis.

Dr A Bednarek from the Medical University of Warsaw, Poland and the CORRIB Research Center at the University of Galway, Ireland under the supervision of Prof A Tomaniak published this interesting paper on the value of the PPG-index. This was a meta-analysis of 13 studies to assess the PPG prognostic impact on clinical and physiological outcomes. In five studies, the pullbacks were performed using the wire-approach, while the other eight were based on angio-based methods. The results from this meta-analysis demonstrate that compared to focal lesions, diffuse lesions had significantly lower post-PCI FFR values and significantly (1.93-fold) more frequent suboptimal post-PCI physiological results. Diffuse lesions were significantly associated with the composite of clinical events (1.71-fold higher risk). The prognostic utility of PPG derived from non-invasive angio-based measures (QFR and CT-derived FFR) was evaluated in a sub analysis including only studies using non-invasive methods. Results were consistent with the overall analysis of clinical events (2.01-fold risk of target vessel revascularization). All of these findings confirm that objectively defined patterns of CAD using PPG have a significant impact on patient risk stratification.

Angiography-derived fractional flow reserve- vs usual care-guided percutaneous coronary intervention: interim analysis of the Pioneer IV trial.

Prof PW Serruys from the CORRIB Research Center for Advanced Imaging and Core Laboratory, University of Galway, Ireland and local PIs of the Pioneer IV trial published this very important paper in the Eur Heart Journal as a Rapid Communication. The PIONEER IV (NCT04923191) is a multicentre, 1:1 randomized, open-label, all-comer, non-inferiority trial comparing clinical outcomes of PCI guided by QFR vs usual care, enrolling patients irrespective of clinical presentation or lesion complexity with unrestricted use in both arms of the Healing-Targeted Supreme sirolimus-eluting stent. This is the interim-analysis of the first 1270 patients (60% of the entire study population), with 631 randomized to the Medis QFR arm and 639 to the usual care arm, with a 1 year FU in 622 (98.6%) and 618 (96,7%), respectively. The mean number of implanted stents and the total stent length per patient were 1.6 stents and 34.0 mm in the QFR arm and 1.6 stents and 34.8 mm in the usual care arm. Intravascular imaging was used in 4.6% and 5.3% of the QFR and usual care patients, respectively. Post-PCI physiology was assessed in 76.5% of the QFR arm patients, with 17.9% (56/313) having an angio-FFR < 0.91, leading to additional treatment in 19.6% (11/56) of cases. The 1-year POCE rates were 6.9% in the QFR arm and 6.8% in the usual care arm. With a risk difference of 0.11%, non-inferiority was declared. The authors concluded that, QFR-guided PCI was non-inferior to usual care; these results must be confirmed in the whole population of 2130 patients.

Correlation between angiography-based physiology and plaque characteristics and clinical outcomes in patients with coronary artery disease.

Dr Y Sasahira and coworkers under the supervision of Dr S Uemura published this very interesting paper in the International Journal of Cardiology. This is a single center, observational, retrospective study from the Dept of Cardiology, Kawasaki Medical School in Japan, including a total of 216 patients with ≥ 25% diameter stenosis in the LAD, who underwent QFR (V2.1) and OCT evaluation. Based on the QFR pullback indices, such as PPG and dQFR/ds, the patients were divided into 4 groups. Group 3 with diffuse disease (low PPG, and major gradient) showed the highest number of lipid rich plaques and thin-cap fibroatheroma. This Group 3 also exhibited worse clinical outcomes compared to the other groups. The authors concluded that QFR-derived physiological disease patterns are closely associated with plaque vulnerability and prognosis in CAD. QFR provides a practical tool for identifying high-risk patients and may inform individualized treatment strategies.

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