BACKGROUND Post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) values $0.90 are associated with a low incidence of adverse events. OBJECTIVES The AQVA (Angio-based Quantitative Flow Ratio Virtual PCI Versus Conventional Angio-guided PCI in the Achievement of an Optimal Post-PCI QFR) trial aims to test whether a QFR-based virtual percutaneous coronary intervention (PCI) is superior to a conventional angiography-based PCI at obtaining optimal post-PCI QFR results. METHODS The AQVA trial is an investigator-initiated, randomized, controlled, parallel-group clinical trial. A total of 300 patients (356 study vessels) undergoing PCI were randomized 1:1 to receive either QFR-based virtual PCI or angiography-based PCI (standard of care). The primary outcome was the rate of study vessels with a suboptimal post-PCI QFR value, which was defined as <0.90. Secondary outcomes were procedure duration, stent length/lesion, and stent number/patient. RESULTS Overall, 38 (10.7%) study vessels missed the prespecified optimal post-PCI QFR target. The primary outcome occurred significantly more frequently in the angiography-based group (n = 26, 15.1%) compared with the QFR-based virtual PCI group (n = 12 [6.6%]; absolute difference = 8.5%; relative difference = 57%; P = 0.009). The main cause of a suboptimal result in the angiography-based group is the underestimation of a diseased segment outside the stented one. There were no significant differences among secondary endpoints, although stent length/lesion and stent number/pa-tient were numerically lower in the virtual PCI group (P = 0.06 and P = 0.08, respectively), whereas procedure length was higher in the virtual PCI group (P = 0.06). CONCLUSIONS The AQVA trial demonstrated the superiority of QFR-based virtual PCI over angiography-based PCI with regard to post-PCI optimal physiological results. Future larger randomized clinical trials that demonstrate the superiority of this approach in terms of clinical outcomes are warranted. (Angio-based Quantitative Flow Ratio Virtual PCI Versus Conventional Angio-guided PCI in the Achievement of an Optimal Post-PCI QFR [AQVA]; NCT04664140) (J Am Coll Cardiol Intv 2023;16:783-794) (c) 2023 by the American College of Cardiology Foundation.

QFR-Based Virtual PCI or Conventional Angiography to Guide PCI: The AQVA Trial

Biscaglia, Simone
Primo
;
Verardi, Filippo Maria;Caglioni, Serena;Campana, Roberta;Scala, Antonella;Marrone, Andrea;Pompei, Graziella;Marchini, Federico;Scancarello, Davide;Tumscitz, Carlo;Penzo, Carlo;Erriquez, Andrea;Manfrini, Marco;Campo, Gianluca
Ultimo
2023

Abstract

BACKGROUND Post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) values $0.90 are associated with a low incidence of adverse events. OBJECTIVES The AQVA (Angio-based Quantitative Flow Ratio Virtual PCI Versus Conventional Angio-guided PCI in the Achievement of an Optimal Post-PCI QFR) trial aims to test whether a QFR-based virtual percutaneous coronary intervention (PCI) is superior to a conventional angiography-based PCI at obtaining optimal post-PCI QFR results. METHODS The AQVA trial is an investigator-initiated, randomized, controlled, parallel-group clinical trial. A total of 300 patients (356 study vessels) undergoing PCI were randomized 1:1 to receive either QFR-based virtual PCI or angiography-based PCI (standard of care). The primary outcome was the rate of study vessels with a suboptimal post-PCI QFR value, which was defined as <0.90. Secondary outcomes were procedure duration, stent length/lesion, and stent number/patient. RESULTS Overall, 38 (10.7%) study vessels missed the prespecified optimal post-PCI QFR target. The primary outcome occurred significantly more frequently in the angiography-based group (n = 26, 15.1%) compared with the QFR-based virtual PCI group (n = 12 [6.6%]; absolute difference = 8.5%; relative difference = 57%; P = 0.009). The main cause of a suboptimal result in the angiography-based group is the underestimation of a diseased segment outside the stented one. There were no significant differences among secondary endpoints, although stent length/lesion and stent number/pa-tient were numerically lower in the virtual PCI group (P = 0.06 and P = 0.08, respectively), whereas procedure length was higher in the virtual PCI group (P = 0.06). CONCLUSIONS The AQVA trial demonstrated the superiority of QFR-based virtual PCI over angiography-based PCI with regard to post-PCI optimal physiological results. Future larger randomized clinical trials that demonstrate the superiority of this approach in terms of clinical outcomes are warranted. (Angio-based Quantitative Flow Ratio Virtual PCI Versus Conventional Angio-guided PCI in the Achievement of an Optimal Post-PCI QFR [AQVA]; NCT04664140) (J Am Coll Cardiol Intv 2023;16:783-794) (c) 2023 by the American College of Cardiology Foundation.
2023
Biscaglia, Simone; Verardi, Filippo Maria; Tebaldi, Matteo; Guiducci, Vincenzo; Caglioni, Serena; Campana, Roberta; Scala, Antonella; Marrone, Andrea; Pompei, Graziella; Marchini, Federico; Scancarello, Davide; Pignatelli, Gianluca; D'Amore, Sergio Musto; Colaiori, Iginio; Demola, Pierluigi; Di Serafino, Luigi; Tumscitz, Carlo; Penzo, Carlo; Erriquez, Andrea; Manfrini, Marco; Campo, Gianluca
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2520410
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