Original Research

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 CABG were substantial for both revascularisation modes (Cohen’s kappa=0.72 [95% CI: 0.66-0.78] and 0.72 [95% CI: 0.66-0.78], respectively). The team assigned to the QFR approach provided consistent recommended revascularisation modes even after being made aware of the FFR data (Cohen’s kappa=0.95 [95% CI:0.90-1.00]).

CONCLUSIONS: QFR provided feasible physiological data in Heart Team discussions to determine the optimal revascularisation strategy for MVD. The QFR and FFR approaches agreed substantially in terms of treatment recommendations.

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Volume 20 Number 9
May 10, 2024
Volume 20 Number 9
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