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Randomized Controlled Trial
. 2025 Feb 3;21(3):e161-e170.
doi: 10.4244/EIJ-D-24-01001.

Coronary revascularisation deferral based on quantitative flow ratio or fractional flow reserve: a post hoc analysis of the FAVOR III Europe trial

Birgitte K Andersen  1 , Niels R Holm  1 , Lone J H Mogensen  1 , Luc Maillard  2 , Truls Råmunddal  3 , Andrea Erriquez  4 , Evald H Christiansen  1 , Javier Escaned  5 , On Behalf Of The Favor Iii Europe Study Team
Affiliations
Randomized Controlled Trial

Coronary revascularisation deferral based on quantitative flow ratio or fractional flow reserve: a post hoc analysis of the FAVOR III Europe trial

Birgitte K Andersen et al. EuroIntervention. .

Abstract

Background: Safe deferral of revascularisation is a key aspect of physiology-guided percutaneous coronary intervention (PCI). While recent evidence gathered in the FAVOR III Europe trial showed that quantitative flow ratio (QFR) guidance did not meet non-inferiority to fractional flow reserve (FFR) guidance, it remains unknown if QFR might have a specific value in revascularisation deferral.

Aims: We aimed to evaluate the safety of coronary revascularisation deferral based on QFR as compared with FFR.

Methods: Patients randomised in the FAVOR III trial in whom PCI was deferred in at least one coronary artery, based on QFR or FFR>0.80, were included in the present substudy. The primary outcome was the 1-year rate of major adverse cardiac events (MACE), with results reported for two subsets of deferred patients: (1) any study lesion deferral and (2) complete study lesion deferral.

Results: A total of 523 patients (55.2%) in the QFR group and 599 patients (65.3%) in the FFR group had at least one coronary revascularisation deferral. Of these, 433 patients (82.8%) and 511 (85.3%) patients, respectively, had complete study lesion deferral. In the "complete study lesion deferral" patient group, the occurrence of MACE was significantly higher in QFR-deferred patients as compared with FFR-deferred patients (24 [5.6%] vs 14 [2.8%], adjusted hazard ratio [HR] 2.07, 95% confidence interval [CI]: 1.07-4.03; p=0.03). In the subgroup of "any study lesion deferral", the MACE rate was 5.6% vs 3.6% (QFR vs FFR), adjusted HR 1.55, 95% CI: 0.88-2.73; p=0.13.

Conclusions: QFR-based deferral of coronary artery revascularisation resulted in a higher incidence of 1-year MACE as compared with FFR-based deferral.

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Conflict of interest statement

B.K. Andersen: institutional research grant from Medis Medical Imaging. N.R. Holm: institutional research grants from Abbott, B. Braun, Biosensors, Boston Scientific, and Medis Medical Imaging; and speaker fees from Abbott and EPS Vascular. A. Erriquez: educational grants from Philips, Abbott, and MLCTO; support for course participation from CoreAalst; and speaker fees from Eukon. T. Råmunddal: consultant and proctoring honoraria from Boston Scientific, EPS Vascular, and Cardirad. E.H. Christiansen: institutional research grants from Abbott, Biosensors, Meril Life Sciences, and Medis Medical Imaging; and speaker fees from Abbott and EPS Vascular. J. Escaned: personal fees as speaker and/or advisory board member from Abbott, Boston Scientific, Medis Medical Imaging, and Philips. The other authors have no conflicts of interest to declare.

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