Are Angiographically-Derived Coronary Physiology Measurements Ready for Use in the Cath Lab?

A randomized trial with a surprising result suggests that caution is warranted for now.

Although invasive physiologic lesion assessment with fractional flow reserve (FFR) has been shown to improve outcomes in patients being considered for coronary revascularization, it is underutilized in practice, which has been attributed to expense and inconvenience. The quantitative flow ratio (QFR) — a recently developed angiography-based computational method for estimating FFR — has been shown to correlate well with FFR and led to improved outcomes compared with coronary angiography alone in the FAVOR III China trial (NEJM JW Cardiol Dec 1 2021 and Lancet 2021; 398:2149). However, whether outcomes are comparable with QFR-guided versus FFR-guided revascularization is unknown.

In the FAVOR III Europe trial (NCT03729739), investigators rando…

Reviewing Author

David J. Cohen, MD, MSc

Disclosures

Consultant/Advisory BoardMedtronic; Edwards Lifesciences; Abbott Vascular; Boston Scientific; St. Francis Hospital

Speaker’s BureauBoston Scientific; ZOLL Medical

Grant/Research SupportEdwards Lifesciences; Abbott Vascular; Boston Scientific; Corvia Medical; National Heart, Lung, and Blood Institute; Phillips, Inc.; St. Paul’s Hospital; V-Wave, Inc; ZOLL Medical; CathWorks, ANCORA

Editorial BoardsJACC; American Heart Journal; EuroIntervention; JSCAI; Structural Heart Journal

Leadership Positions in Professional SocietiesSociety of Thoracic Surgeons/American College of Cardiology TVT Registry (Co-Chair, Risk Model Development Committee); Cardiovascular Research Foundation (Co-Director, TCT Annual Meeting; Co-Director, New York Valves Annual Meeting)