Background This study explores the impact of QFR guidance angioplasty and the subsequent 1-year outcomes in patients with intermediate coronary artery lesions.

Objectives The primary objective of this study was to evaluate the effectiveness of Quantitative Flow Ratio (QFR) guidance in influencing clinical outcomes in patients with intermediate coronary lesions undergoing angioplasty. Specifically, the study aimed to assess the target vessel's failure (TVF) at one year, which includes acute coronary syndrome (ACS), cardiac death, and ischemia-driven target vessel revascularization (TVR). The secondary objectives were total mortality, including cardiac death and non-cardiac death.

Material and Methods This study was conducted over one year, from January 1 to July 31, 2023, and included all patients undergoing coronary angiography. The patients were divided into three arms during the study: medical therapy after QFR reading, QFR-guided PCI, and PCI without QFR. One-year outcomes were then determined for target vessel failure, defined as an acute coronary syndrome (ACS), cardiac death, and ischemia-driven target vessel revascularization (TVR). The secondary objectives were total mortality, including cardiac death and non-cardiac death.

Results The study included 244 patients divided into three groups: QFR-guided PCI (n=47), PCI without QFR (n=122), and medical therapy (n=75). Malays predominantly underwent PCI without QFR guidance (36.1%), while the Chinese population was more represented in the PCI with QFR group (49.2%). Hypertension emerged as the most prevalent risk factor across both groups, affecting 79.5% of patients in the PCI without QFR group and 73% in the PCI with QFR group. The QFR-guided PCI group had the lowest incidence of TVF (2.1%) compared to PCI without QFR (7.4%) and medical therapy (8.0%). However, these differences were not statistically significant (P = 0.38). Similarly, no significant differences among the groups were found in the ACS, cardiac death, or TVR rates. All-cause mortality was also lower in the QFR-guided PCI group (0%) compared to the other two groups, but the difference was not statistically significant (P = 0.211). In logistic regression analysis, QFR-guided PCI showed a trend toward reduced odds of TVF OR = 0.25 [95% CI: 0.03–2.15], and ACS OR = 0.39 [95% CI: 0.04–3.56] compared to medical therapy, but these findings were not statistically significant (P = 0.22 and P = 0.40, respectively). The study suggests that while QFR-guided PCI may reduce adverse outcomes, larger studies are needed to confirm these potential benefits.

Conclusions The findings of this study highlight the substantial value of Quantitative Flow Ratio (QFR) in guiding percutaneous coronary intervention (PCI) in indeterminate coronary artery lesions with better target vessel failure outcomes. These results suggest that integrating QFR into routine clinical practice could lead to more effective and targeted interventions, reducing unnecessary procedures and optimizing patient care.