Key result
Pre-PCI μQFR accurately identifies significant stenosis with 90% accuracy and predicts 2-year adverse events.
Why the study?
Does post-PCI Murray law-based quantitative flow ratio (μQFR) predict clinical outcomes in patients with angiographically intermediate lesions undergoing PCI?
RCT
Blinded
1:1
Does post-PCI Murray law-based quantitative flow ratio (μQFR) predict clinical outcomes in patients with angiographically intermediate lesions undergoing PCI?
p-value: p=0.022
Lower post-PCI μQFR values predict subsequent adverse events in patients with intermediate lesions undergoing PCI, suggesting it may be a promising alternative to FFR.
Background: Coronary physiology measured by fractional flow reserve (FFR) is superior to angiography for assessing the efficacy of percutaneous coronary intervention (PCI). Yet, the clinical adoption of post-PCI FFR is limited. Murray law-based quantitative flow ratio (μQFR) may represent a promising alternative, as it can quickly compute FFR from a single angiographic view. Objectives: The authors aimed to investigate the potential role of post-PCI μQFR in predicting clinical outcomes. Methods: This was a post hoc blinded analysis of the FLAVOUR trial. Patients with angiographically intermediate lesions randomized 1:1 to receive FFR or intravascular ultrasound-guided PCI were included. Post-PCI μQFR was assessed in successfully stented vessels, blinded to clinical outcomes. Suboptimal physiological outcome post-PCI was defined a priori as post-PCI μQFR <0.90. The primary endpoint was 2-year target vessel failure, including cardiac death, target vessel myocardial infarction, and target vessel revascularization. Secondary endpoints included the diagnostic concordance of pre-PCI μQFR with FFR in the FFR-guidance arm. Results: 0.022). Pre-PCI μQFR was obtained in 877 of 919 vessels (feasibility 95.4%), showing 90% accuracy, 82% sensitivity, and 94% specificity for identifying physiologically significant stenosis defined by pre-PCI FFR ≤0.80. Conclusions: In patients with intermediate lesions who underwent PCI with contemporary imaging or physiology guidance, lower post-PCI μQFR values predict subsequent adverse events. (Fractional FLow Reserve And IVUS for Clinical OUtcomes in Patients With InteRmediate Stenosis [FLAVOUR]; NCT02673424).
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Ding et al. (2025) conducted an RCT in Angiographically intermediate coronary lesions. Post-PCI Murray law-based quantitative flow ratio (μQFR) vs. Suboptimal physiological outcome post-PCI (μQFR <0.90) was evaluated on 2-year target vessel failure, including cardiac death, target vessel myocardial infarction, and target vessel revascularization (p=0.022). Lower post-PCI μQFR values predicted subsequent adverse events at 2 years (P=0.022), and pre-PCI μQFR showed 90% accuracy for identifying physiologically significant stenosis.
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