Taku Asano; Toru Tanigaki; Masahiro Hoshino; Motoki Yasunaga; Hideaki Nonaka; Hiroki Emori; Yuki Katagiri; Yosuke Miyazaki; Yohei Sotomi; Norihiro Kogame; Shoichi Kuramitsu; Akira Saito; Kotaro Miyata; Yoshimitsu Takaoka; Takayoshi Kanie; Manabu Yamasaki; Kunihiko Yoshino; Naoki Wakabayashi; Kouki Ouchi; Hiroyuki Kodama; Yumi Shiina; Rihito Tamaki; Yosuke Nishihata; Keita Masuda; Takahiro Suzuki; Johan  H.C. Reiber; Takayuki Okamura; Yoshiharu Higuchi; Tsunekazu Kakuta; Hiroyasu Misumi; Kohei Abe; Nobuyuki Komiyama; Kengo Tanabe; Hitoshi Matsuo; on behalf of the DECISION QFR investigators

doi:10.4244/EIJ-D-23-00674

Quantitative flow ratio versus fractional flow reserve for Heart Team decision-making in multivessel disease: the randomised, multicentre DECISION QFR trial

Taku Asano¹, MD, PhD; Toru Tanigaki², MD; Masahiro Hoshino³, MD, PhD; Motoki Yasunaga⁴, MD; Hideaki Nonaka⁵, MD; Hiroki Emori⁶, MD, PhD; Yuki Katagiri⁷, MD, PhD; Yosuke Miyazaki⁸, MD, PhD; Yohei Sotomi⁹, MD, PhD; Norihiro Kogame¹⁰, MD, PhD; Shoichi Kuramitsu¹¹, MD, PhD; Akira Saito¹, MD, MPH; Kotaro Miyata¹, MD; Yoshimitsu Takaoka¹, MD, MPH; Takayoshi Kanie¹, MD; Manabu Yamasaki¹², MD; Kunihiko Yoshino¹², MD; Naoki Wakabayashi¹³, BRT; Kouki Ouchi¹³, BRT; Hiroyuki Kodama¹, MD; Yumi Shiina¹, MD, PhD; Rihito Tamaki¹², MD; Yosuke Nishihata¹, MD, PhD; Keita Masuda¹, MD, PhD; Takahiro Suzuki¹, MD, MPH; Johan H.C. Reiber¹⁴, PhD; Takayuki Okamura⁸, MD, PhD; Yoshiharu Higuchi⁴, MD, PhD; Tsunekazu Kakuta³, MD, PhD; Hiroyasu Misumi¹², MD, PhD; Kohei Abe¹², MD; Nobuyuki Komiyama¹, MD, PhD; Kengo Tanabe⁵, MD, PhD; Hitoshi Matsuo², MD, PhD; on behalf of the DECISION QFR investigators

Abstract

BACKGROUND: Vessel-level physiological data derived from pressure wire measurements are one of the important determinant factors in the optimal revascularisation strategy for patients with multivessel disease (MVD). However, these may result in complications and a prolonged procedure time.

AIMS: The feasibility of using the quantitative flow ratio (QFR), an angiography-derived fractional flow reserve (FFR), in Heart Team discussions to determine the optimal revascularisation strategy for patients with MVD was investigated.

METHODS: Two Heart Teams were randomly assigned either QFR- or FFR-based data of the included patients. They then discussed the optimal revascularisation mode (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) for each patient and made treatment recommendations. The primary endpoint of the trial was the level of agreement between the treatment recommendations of both teams as assessed using Cohen’s kappa.

RESULTS: The trial included 248 patients with MVD from 10 study sites. Cohen’s kappa in the recommended revascularisation modes between the QFR and FFR approaches was 0.73 [95% confidence interval {CI} : 0.62-0.83]. As for the revascularisation planning, agreements in the target vessels for PCI and...

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