Two-year outcomes of quantitative flow ratio-based physiology-guided percutaneous coronary intervention in patients with low-risk acute coronary syndrome: a prespecified secondary analysis of FAVOR III China
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Le résumé fourni par la source
Background The benefits of physiology-guided management in acute coronary syndrome (ACS) remain inconclusive due to limited evidence. In our FAVOR III China trial, a quantitative flow ratio (QFR)-based physiology-guided strategy versus standard angiography guidance improved the 1-year primary outcome among participants with coronary artery disease (CAD). We aimed to investigate, in a prespecified analysis, the outcomes of QFR-based physiological guidance in the FAVOR III China participants with low-risk ACS. Methods This pre-specified secondary analysis included patients diagnosed with low-risk ACS who were enrolled in the FAVOR III China trial. The trial was a prospective, randomised study that assigned 3825 CAD patients to receive QFR-guided or angiography-guided percutaneous coronary intervention (PCI) at 26 hospitals in China between December, 2018 and January, 2020. The primary outcome of interest for this study was major adverse cardiac events (MACE), defined as a composite of all-cause death, myocardial infarction, and ischaemia-driven revascularisation, at 1-year (primary outcome of FAVOR III China) and 2-year follow-up. Secondary outcomes included PCI strategy change and the procedural characteristics. FAVOR III China is registered with ClinicalTrials.gov, NCT03656848. Findings Of the 2371 participants with low-risk ACS (93.7% unstable angina and 6.3% non-ST elevation myocardial infarction [NSTEMI]) in the FAVOR III China trial, the QFR-guided strategy changed the original intended treatment plan in 23.6% of the low-risk ACS patients, resulting in more PCI deferrals (19.0% vs 3.8%; P < 0.001), less stenting (1.5 ± 1.1 vs 1.6 ± 1.0 per participant; P = 0.034), and shorter fluoroscopy time (13.7 ± 7.7 min vs 14.6 ± 7.1 min; P = 0.01) compared with the angiography-guided strategy. During follow-up, there was some evidence that the QFR guided strategy is superior to the angiography-guided approach at reducing the risk of MACE at 1-year follow-up (6.1% vs 8.2%; HR, 0.74; 95% CI, 0.54–1.01, P = 0.055), with a significant risk reduction at 2-year follow-up (8.3% vs 11.7%; HR, 0.70; 95% CI, 0.54–0.91, P = 0.009). The landmark analysis indicated consistent patterns both before and after 1 year ( P interaction = 0.35). Interpretation Our findings favoured the superiority of QFR-guided lesion selection strategy over standard angiography guidance in reducing long-term MACE for the low-risk ACS population. The benefits associated with QFR need to be confirmed by future studies with extended follow-up. Funding The National High Level Hospital Clinical Research Funding, the Capital's Funds for Health Improvement and Research, the Chinese Academy of Medical Sciences, the Noncommunicable Chronic Diseases National Science and Technology Major Project, Shanghai Municipal Health Commission "Top Priority Research Centre", and Shanghai Shenkang Hospital Development Centre.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Two-year outcomes of quantitative flow ratio-based physiology-guided percutaneous coronary intervention in patients with low-risk acute coronary syndrome: a prespecified secondary analysis of FAVOR III China
- Date Crossref
- 01/10/2025
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Shanghai Jiao Tong University Department of Cardiology pays non établi dans la noticeUniversité ou école supérieure
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UNSW Sydney pays non établi dans la noticeUniversité ou école supérieure
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The George Institute for Global Health pays non établi dans la noticeStructure de recherche
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Tongji University Department of Cardiology pays non établi dans la noticeUniversité ou école supérieure
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Tongji Hospital pays non établi dans la noticeÉtablissement de santé
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Peking University Department of Cardiology pays non établi dans la noticeUniversité ou école supérieure
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Peking University Third Hospital pays non établi dans la noticeÉtablissement de santé
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Shanghai Sixth People's Hospital pays non établi dans la noticeÉtablissement de santé
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Jiangsu University pays non établi dans la noticeUniversité ou école supérieure
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Xuzhou Medical College pays non établi dans la noticeUniversité ou école supérieure
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Xuzhou Cancer Hospital pays non établi dans la noticeÉtablissement de santé
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Hunan Normal University Department of Cardiology pays non établi dans la noticeUniversité ou école supérieure
Department of Cardiology — Shanghai Jiao Tong University, UNSW Sydney et The George Institute for Global Health, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.