Prognostic Value of Postpercutaneous Coronary Intervention Murray-Law-Based Quantitative Flow Ratio Post Hoc Analysis From FLAVOUR Trial

초록

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 (mu QFR) 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 mu QFR 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 mu QFR was assessed in successfully stented vessels, blinded to clinical outcomes. Suboptimal physiological outcome post-PCI was defined a priori as post-PCI mu QFR <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 <mu>QFR with FFR in the FFR-guidance arm. RESULTS Post-PCI mu QFR was successfully analyzed in 806 vessels from 777 participants (feasibility 97.0% [806 of 831]). Suboptimal physiological outcome post-PCI was identified in 24.7% (199 of 806) of vessels and post-PCI mu QFR <0.90 was associated with higher risk of 2-year target vessel failure (6.1% [12 of 199] vs 2.7% [16 of 607]; HR: 2.45 [95% CI: 1.14-5.26]; P 1/4 0.022). Pre-PCI <mu>QFR 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 mu QFR values predict subsequent adverse events. (Fractional FLow Reserve And IVUS for Clinical OUtcomes in Patients With InteRmediate Stenosis [FLAVOUR]; NCT02673424) (JACC Asia. 2025;5:59-70) (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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