Abstract Introduction Physiology-based PCI is recommended by the ESC guidelines for coronary revascularization in patients with chronic coronary artery disease. Despite 1A class recommendations, physiology-based PCIs account for only 10% of all PCIs worldwide due to their cost and time requirements. Angiography-based FFRs have been introduced into clinical practice, but long-term survival outcomes comparing QFR and FFR still lack. Aim This study aims to assess 5-year outcomes in patients with chronic coronary artery disease and intermediate (40-90%) coronary artery lesions, treated according to QFR or FFR. Methods This is a follow-up study assessing outcomes of patients treated according to QFR or FFR measurements. In total, 784 patients treated for chronic coronary syndrome (CCS) at our hospital between 1 November 2018 and 31 December 2023 were included in this single-center study. For all included patients, an invasive coronary artery angiography revealing intermediate coronary artery lesions (lumen stenosis 40-90%) accompanied by invasive physiology evaluation by QFR or FFR was performed. FU was performed by phone; if patients were unreachable, the medical database was checked for potential MACE or cause-of-death events. Survival was analyzed using the Kaplan-Meier method in SPSS 28.0, with a significance level of p 0.05. Results In total, two patients were lost to follow-up, resulting in 99.74% FU availability. Of all included physiology evaluation methods, 392 (50%) were QFRs. Two patients died (one in the QFR and one in the FFR group); seven patients experienced MACE (3 in the QFR and 4 in the FFR group). There were no statistically significant differences between the two methods for combined MACE and any-cause death outcomes. Mean survival time in QFR vs FFR was 1813.01 (SD. 6.93) vs 1809.28 (SD 7.84), p = .704. Conclusions This is the first QFR vs FFR 5-year outcomes study to report no statistically significant differences in such a large study population over the 5-year follow-up period. This study may raise the idea of re-evaluating and debating previously published data on QFR noninferiority over FFR (FAVOR III), where QFR failed to demonstrate noninferiority. This study shows promising results towards broader re-evaluation of QFR’s applicability in everyday clinical practice.
Žiubrytė et al. (Sun,) studied this question.