“FAVOR III Europe: A Randomized Trial of QFR vs. FFR in Intermediate Coronary Stenoses”

 QFR (Quantitative Flow Ratio) is a non-invasive, angiography-based method to estimate FFR (Fractional Flow Reserve) without using a pressure wire or adenosine, thus reducing risks and patient discomfort. In the FAVOR III Europe trial, QFR did not match FFR in 12-month clinical outcomes for intermediate coronary stenosis, showing a higher MACE rate (6.7% vs. 4.2%) compared to FFR.

Differences between coronary functional tests: 

1. QFR uses computer software on angiograms, whereas FFR requires a pressure wire under adenosine.

2. IFR (Instantaneous Wave-Free Ratio) is another non-hyperemic, wire-based technique, similar to DFR (Diastolic Flow Ratio), both used without adenosine but still wire-based.

3. QFR was associated with 21% more revascularizations and 27% more stents compared to FFR, indicating it may lead to more intervention due to detecting lower QFR values.

4. Procedure times were similar, but FFR had longer fluoroscopy time.

Conclusions:

• QFR, while promising, may need further refinement and does not currently replace FFR when FFR is available.

• Future trials may clarify if other wire-free methods could rival FFR in accuracy and reliability.