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Review
. 2025 Jul 15;14(14):5015.
doi: 10.3390/jcm14145015.

Quantitative Flow Ratio-Guided vs. Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of One-Year Clinical Outcomes

Viet Nghi Tran  1 , Amreen Dhindsa  1 , Kuchalambal Agadi  1 , Hoang Nhat Pham  2 , Hong Hieu Truong  3 , Chau Doan Nguyen  4 , Hanad Bashir  5   6 , Huan Dat Pham  7 , Thanh Vien Truong  5 , Phillip Tran  8 , Thach Nguyen  9
Affiliations
Review

Quantitative Flow Ratio-Guided vs. Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of One-Year Clinical Outcomes

Viet Nghi Tran et al. J Clin Med. .

Abstract

Background: Quantitative Flow Ratio (QFR) is a novel, wire-free, and hyperemia-free physiological assessment for guiding Percutaneous Coronary Intervention (PCI), which may offer advantages over traditional angiography-guided PCI. This systematic review with meta-analysis compares clinical outcomes after one year in patients who underwent QFR-guided versus angiography-guided PCI. Methods: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on 4 November 2024 in PROSPERO (ID: CRD42024609799). A systematic search was performed across multiple databases to identify clinical trials comparing QFR-guided and angiography-guided PCI. Random-effects models were used to assess one-year outcomes of major adverse cardiovascular events (MACEs), revascularization, and rehospitalization, with heterogeneity measured using I2, H2, and Cochran's Q statistics. Study quality was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool. Results: Compared to traditional angiography-guided PCI, QFR-guided PCI was associated with numerically lower but statistically non-significant risks of MACEs (risk difference: -0.08, 95% CI: -0.20 to 0.04), revascularization (risk difference: -0.02, 95% CI: -0.08 to 0.03), and rehospitalization (risk difference: -0.02, 95% CI: -0.08 to 0.04) over one year. Substantial heterogeneity was observed for MACEs (I2 = 84.95%, H2 = 6.64) and revascularization (I2 = 94.18%, H2 = 17.18), whereas rehospitalization exhibited low heterogeneity (I2 = 17.17%, H2 = 1.21). The risk of bias was assessed by the RoB 2 tool, which revealed low to some concern risk of bias across key domains. Conclusions: Quantitative Flow Ratio (QFR) has demonstrated comparable one-year clinical outcomes to traditional angiography for PCI guidance, with a trend toward improved results. However, the high heterogeneity among studies and the risk of bias necessitate the need for larger, high-quality trials to validate these findings.

Keywords: FFR; MACE; QFR-guided PCI; iFR; percutaneous coronary intervention (PCI); quantitative flow ratio (QFR); revascularization; vFFR.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram for results of the systematic search.
Figure 2
Figure 2
Pooled analysis for MACEs [15,16,17].
Figure 3
Figure 3
Pooled analysis for repeated revascularization [15,16,17].
Figure 4
Figure 4
Pooled analysis for rehospitalization [15,16].
Figure 5
Figure 5
Cochrane Risk of Bias 2 Assessment [15,16,17].
See this image and copyright information in PMC

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References

    1. Layland J., Oldroyd K.G., Curzen N., Sood A., Balachandran K., Das R., Junejo S., Ahmed N., Lee M.M.Y., Shaukat A., et al. Fractional Flow Reserve vs. Angiography in Guiding Management to Optimize Outcomes in Non-ST-Segment Elevation Myocardial Infarction: The British Heart Foundation FAMOUS-NSTEMI Randomized Trial. Eur. Heart J. 2015;36:100–111. doi: 10.1093/eurheartj/ehu338. - DOI - PMC - PubMed
    1. Fearon W.F., Bornschein B., Tonino P.A.L., Gothe R.M., De Bruyne B., Pijls N.H.J., Siebert U. Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) Study Investigators Economic Evaluation of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Patients with Multivessel Disease. Circulation. 2010;122:2545–2550. doi: 10.1161/CIRCULATIONAHA.109.925396. - DOI - PubMed
    1. Jeremias A., Kirtane A.J., Stone G.W. A Test in Context: Fractional Flow Reserve: Accuracy, Prognostic Implications, and Limitations. J. Am. Coll. Cardiol. 2017;69:2748–2758. doi: 10.1016/j.jacc.2017.04.019. - DOI - PubMed
    1. van de Hoef T.P., Nolte F., EchavarrÍa-Pinto M., van Lavieren M.A., Damman P., Chamuleau S.A.J., Voskuil M., Verberne H.J., Henriques J.P.S., van Eck-Smit B.L.F., et al. Impact of Hyperaemic Microvascular Resistance on Fractional Flow Reserve Measurements in Patients with Stable Coronary Artery Disease: Insights from Combined Stenosis and Microvascular Resistance Assessment. Heart. 2014;100:951–959. doi: 10.1136/heartjnl-2013-305124. - DOI - PubMed
    1. Tanaka H., Matsumoto H., Takahashi H., Hosonuma M., Sato S., Ogura K., Oishi Y., Masaki R., Sakai K., Sekimoto T., et al. Linear Concentration-Response Relationship of Serum Caffeine with Adenosine-Induced Fractional Flow Reserve Overestimation: A Comparison with Papaverine. EuroIntervention. 2021;17:e925–e931. doi: 10.4244/EIJ-D-21-00453. - DOI - PMC - PubMed

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