Quantitative Flow Ratio-Guided vs. Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of One-Year Clinical Outcomes

TL;DR

This study compares the one-year outcomes of heart procedures guided by a new technique called QFR versus traditional angiography, finding similar results but highlighting the need for more research.

Contribution

The study provides a systematic review and meta-analysis comparing QFR-guided and angiography-guided PCI outcomes, emphasizing the need for further high-quality trials.

Findings

QFR-guided PCI showed numerically lower but not statistically significant risks of MACEs, revascularization, and rehospitalization compared to angiography-guided PCI.

High heterogeneity was observed in MACEs and revascularization outcomes, suggesting variability across studies.

Low risk of bias was found in most studies, but larger trials are needed to confirm results.

Abstract

Background: Quantitative Flow Ratio (QFR) is a novel, wire-free, and hyperemia-free physiological assessment for guiding Percutaneous Coronary Intervention (PCI), which may offer advantages over traditional angiography-guided PCI. This systematic review with meta-analysis compares clinical outcomes after one year in patients who underwent QFR-guided versus angiography-guided PCI. Methods: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on 4 November 2024 in PROSPERO (ID: CRD42024609799). A systematic search was performed across multiple databases to identify clinical trials comparing QFR-guided and angiography-guided PCI. Random-effects models were used to assess one-year outcomes of major adverse cardiovascular events (MACEs), revascularization, and rehospitalization, with heterogeneity measured using I2, H2, and Cochran’s Q statistics. Study quality was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool. Results: Compared to traditional angiography-guided PCI, QFR-guided PCI was associated with numerically lower but statistically non-significant risks of MACEs (risk difference: −0.08, 95% CI: −0.20 to 0.04), revascularization (risk difference: −0.02, 95% CI: −0.08 to 0.03), and rehospitalization (risk difference: −0.02, 95% CI: −0.08 to 0.04) over one year. Substantial heterogeneity was observed for MACEs (I2 = 84.95%, H2 = 6.64) and revascularization (I2 = 94.18%, H2 = 17.18), whereas rehospitalization exhibited low heterogeneity (I2 = 17.17%, H2 = 1.21). The risk of bias was assessed by the RoB 2 tool, which revealed low to some concern risk of bias across key domains. Conclusions: Quantitative Flow Ratio (QFR) has demonstrated comparable one-year clinical outcomes to traditional angiography for PCI guidance, with a trend toward improved results. However, the high heterogeneity among studies and the risk of bias necessitate the need for larger, high-quality trials to validate these findings.

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