Quantitative Flow Ratio (QFR) was applicable in only 26.4% of consecutive patients with significant coronary artery disease, with 73.6% presenting at least one anatomical or technical contraindication.
Observational (n=352)
What is the applicability of Quantitative Flow Ratio (QFR) in a consecutive real-world population of patients with significant coronary artery disease?
In a real-world consecutive population of patients with significant CAD, QFR was applicable in only a minority of cases (26.4%) due to anatomical and technical contraindications.
Abstract Background The assessment of the functional severity of coronary artery disease (CAD) is underused world-wide. Angio-based, wire-free and adenosine-free techniques, like Quantitative Flow Ratio (QFR), have been suggested to be an easier alternative that could increase the use of coronary physiology. However, it’s not clear in which patients (pts) this technique can actually be used, neither it’s reproducibility in a real-world scenario, in centers not involved in the investigation of these technologies. Purpose To describe the applicability of QFR in a consecutive population of pts referred for invasive angiography (ICA). Methods The QFR-Real study is a prospective all-comers consecutive registry in which pts with significant CAD (50%, in vessels 2.0 mm) are assessed for QFR measurement, with the purpose of evaluating both the applicability (according to the inclusion criteria in the QFR trials) and the reproducibility of the technique. When QFR analysis is possible, images are collected according to the manufacturer's recommendations. In this pre-defined sub-analysis, we present the results on the applicability of QFR in the screened population, after exclusion of pts who refused or were considered unable to consent, as well as pts with no obstructive CAD, participating in RTCs, with an anatomy not suitable for revascularization or with acute coronary syndromes (ACS) and no other lesions besides the culprit. Results From an initial population of 897 pts, 560 had significant CAD. Of these, 352 pts met all the inclusion criteria, being the population of this analysis. Mean age was 68.1+/-12.7 years and 76.4% were males. Most common indications for ICA were ACS in 203 (57.7) and CCS in 109 (31%). 259 pts (73.6%) presented at least one anatomical/technical contra-indication for performing QFR, including 82 with CTOs, 58 with systolic hypotension (90 mmHg), 33 with renal failure (eGFR 30 ml/kg/min, serum creatinine ≥ 2.5 mg/dL or on dialysis), 32 with in-stent restenosis (ISR) lesions, 21 with TIMI flow 3, 17 with aorto-ostial lesions, and 16 with other technical or clinical contra-indications. As a result, images for QFR measurements were collected in only 93 (26.4%) pts, while invasive physiology would be theoretically possible in 175 (67.6%), according to current technical and clinical standards for this technique. Importantly, of the 203 pts with ACS and other lesions besides the culprit, 154 (75.9%) had at least one contra-indication for QFR evaluation, while only 104 (51.2%) had a contra-indication for invasive physiology evaluation. Data on the quality of the angiography runs and its suitability for use with the QFR software are currently being analyzed and data will be available for the presentation. Conclusions In a consecutive population of pts with significant CAD, including pts with ACS, QFR is only applicable in a minority of cases.
Baptista et al. (Sat,) conducted a observational in coronary artery disease (n=352). Quantitative Flow Ratio (QFR) was evaluated on Applicability of QFR. Quantitative Flow Ratio (QFR) was applicable in only 26.4% of consecutive patients with significant coronary artery disease, with 73.6% presenting at least one anatomical or technical contraindication.