Chen Yundai, Gao Lei, Vogel Birgit, Tian Feng, Jin Qinhua, Guo Jun, Sun Zhijun, Yang Weixian, Jin Zening, Yu Bo, Fu Guosheng, Pu Jun, Qu Xinkai, Zhang Qi, Zhao Yanyan, Yu Lilei, Guan Changdong, Tu Shengxian, Qiao Shubin, Xu Bo, Mehran Roxana, Song Lei
Department of Cardiology, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
Senior Department of Cardiology, the Sixth Medical Center of Chinese PLA General Hospital, Beijing, China.
JACC Asia. 2023 Nov 28;4(3):201-212. doi: 10.1016/j.jacasi.2023.09.012. eCollection 2024 Mar.
FAVOR III China (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) reported improved clinical outcomes in quantitative flow ratio (QFR) relative to angiography-guided percutaneous coronary intervention (PCI), but the clinical impact of QFR-guided PCI according to sex remains unknown.
The authors sought to compare sex differences in the 2-year clinical benefits of a QFR-guided PCI strategy and to evaluate the differences in outcomes between men and women undergoing contemporary PCI.
This study involved a prespecified subgroup analysis of the FAVOR III China trial, in which women and men were randomized to a QFR-guided strategy or a standard angiography-guided strategy. Sex differences in clinical benefit of the QFR guidance were analyzed for major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction, or ischemia-driven revascularization within 2 years.
A total of 1,126 women and 2,699 men were eligible and the occurrence of 2-year MACE was similar between women and men (10.3% vs 10.5%; = 0.96). Compared with an angiography-guided strategy, a QFR-guided strategy resulted in a 7.9% and 9.7% reduction in PCI rates in men and women, respectively. A QFR-guided strategy resulted in similar relative risk reductions for 2-year MACE in women (8.0% vs 12.7%; HR: 0.62; 95% CI: 0.42-0.90) and men (8.7% vs 12.4%; HR: 0.69; 95% CI: 0.54-0.87) ( = 0.61). Furthermore, QFR values were not significantly different between men and women with various angiographic stenosis categories.
A QFR-guided PCI strategy resulted in improved MACE in both men and women at 2 years compared with an angiography-guided PCI strategy. The FAVOR III China Study [FAVOR III China]; (NCT03656848).
“FAVOR III中国研究”（冠状动脉疾病患者定量血流比引导与血管造影引导下经皮介入治疗的比较）报告称，与血管造影引导下经皮冠状动脉介入治疗（PCI）相比，定量血流比（QFR）可改善临床结局，但QFR引导下PCI对不同性别的临床影响尚不清楚。
作者旨在比较QFR引导下PCI策略在2年临床获益方面的性别差异，并评估接受当代PCI的男性和女性在结局上的差异。
本研究涉及对“FAVOR III中国研究”进行预先设定的亚组分析，该试验将男性和女性随机分为QFR引导策略组或标准血管造影引导策略组。分析QFR引导在主要不良心脏事件（MACE，2年内全因死亡、心肌梗死或缺血驱动的血运重建的复合事件）临床获益方面的性别差异。
共有1126名女性和2699名男性符合条件，女性和男性2年MACE的发生率相似（10.3%对10.5%；P = 0.96）。与血管造影引导策略相比，QFR引导策略使男性和女性的PCI率分别降低了7.9%和9.7%。QFR引导策略使女性（8.0%对12.7%；HR：0.62；95%CI：0.42 - 0.90）和男性（8.7%对12.4%；HR：0.69；95%CI：0.54 - 0.87）2年MACE的相对风险降低相似（P = 0.61）。此外，不同血管造影狭窄类别的男性和女性之间QFR值无显著差异。
与血管造影引导下PCI策略相比，QFR引导下PCI策略在2年时可使男性和女性的MACE均得到改善。“FAVOR III中国研究”[FAVOR III China]；（NCT03656848）
