Coronary Intervention Guided by Quantitative Flow Ratio vs Angiography in Patients With or Without Diabetes

Zening Jin; Bo Xu; Xingsheng Yang; Ruofei Jia; Shuai Meng; Hongyu Hu; Yue Deng; Xiaojing Cao; Yang Ruan; Jing Han; Jian Liu; Xinkai Qu; Yujie Zhou; Jian'an Wang; Guosheng Fu; Bo Yu; Yang Wang; Changdong Guan; Lei Song; Shengxian Tu; Shubin Qiao; Gregg W Stone; FAVOR III China Study Group

doi:10.1016/j.jacc.2022.06.044

Coronary Intervention Guided by Quantitative Flow Ratio vs Angiography in Patients With or Without Diabetes

J Am Coll Cardiol. 2022 Sep 27;80(13):1254-1264. doi: 10.1016/j.jacc.2022.06.044.

Authors

Zening Jin¹, Bo Xu², Xingsheng Yang³, Ruofei Jia³, Shuai Meng³, Hongyu Hu³, Yue Deng⁴, Xiaojing Cao³, Yang Ruan³, Jing Han³, Jian Liu⁵, Xinkai Qu⁶, Yujie Zhou⁷, Jian'an Wang⁸, Guosheng Fu⁹, Bo Yu¹⁰, Yang Wang¹¹, Changdong Guan⁴, Lei Song⁴, Shengxian Tu¹², Shubin Qiao⁴, Gregg W Stone¹³; FAVOR III China Study Group

Affiliations

¹ Cardiology and Cardiac Macrovascular Surgical Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address: zeningjin@qq.com.
² Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, China. Electronic address: bxu@citmd.com.
³ Cardiology and Cardiac Macrovascular Surgical Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁴ Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁵ Department of Cardiology, Peking University People's Hospital, Beijing, China.
⁶ Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
⁷ Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
⁸ Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁹ Department of Cardiology, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
¹⁰ Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, China.
¹¹ Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China.
¹² Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
¹³ Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

PMID: 36137676
DOI: 10.1016/j.jacc.2022.06.044

Abstract

Background: The clinical utility of the quantitative flow ratio (QFR), a novel angiography-based index for the functional assessment of coronary stenoses, has recently been demonstrated in patients undergoing percutaneous coronary intervention (PCI).

Objectives: This study aimed to ascertain whether the beneficial outcomes of QFR guidance for lesion selection during PCI is affected by diabetes status.

Methods: This substudy from the FAVOR III China trial, in which diabetes was one of the prespecified factors for stratified randomization, compared clinical outcomes of QFR-guided vs angiography-guided PCI lesion selection according to the presence of diabetes. The primary endpoint was the 1-year risk of major adverse cardiac events (MACE) (a composite of all-cause death, myocardial infarction, or ischemia-driven revascularization).

Results: Among 3,825 patients enrolled, 1,295 (33.9%) had diabetes, 347 (26.8%) of whom were treated with insulin. Baseline characteristics were well balanced between treatment arms in both diabetic and nondiabetic patients. Compared with standard angiography-based lesion selection, the QFR-guided strategy consistently reduced the risk of 1-year MACE in both diabetic patients (6.2% vs 9.6%; HR: 0.64; 95% CI: 0.43-0.95) and nondiabetic patients (5.6% vs 8.3%; HR: 0.66; 95% CI: 0.49-0.89) (P_interaction = 0.88). Among patients in whom PCI was deferred after QFR, the risk of 1-year MACE was similar in patients with and without diabetes (4.5% vs 6.2%; P = 0.51).

Conclusions: A QFR-guided lesion selection strategy improves PCI outcomes compared with standard angiography guidance in patients both with and without diabetes. (The Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease [FAVOR III China Study]; NCT03656848).

Keywords: angiography; clinical outcomes; diabetes mellitus; percutaneous coronary intervention; quantitative flow ratio.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Coronary Angiography
Coronary Artery Disease*
Diabetes Mellitus* / epidemiology
Fractional Flow Reserve, Myocardial*
Humans
Insulins*
Percutaneous Coronary Intervention* / adverse effects
Treatment Outcome

Substances

Insulins

Associated data

ClinicalTrials.gov/NCT03656848