Hello, So my name is Taku Asano.
I'm working at St. Luke's International Hospital
in Tokyo, Japan.
Today I'd like to talk about
the result of the DESCISION QFR Trial.
The reasoning behind the study is
that the patient risk assessment
considering the coronary anatomy
and its physiological significance
which is represented
by the functional syntax core
demonstrated the better capability
in predicting the outcomes after the revascularization
in patients with multivessel disease,
and compared to the one considering only anatomy.
However multivessel integration
of the FFO may have some difficulty
in the catheter laboratory,
because it potentially has the vessel injury,
and the excess procedure time.
The QFR, the quantitative flow ratio
which is the FFR simulation that based
on the angiographic images,
this potentially increase the
functions
and increase the practicability of the functional
syntax score without using the pressure wire
or the pharmaceutical hyperimmune.
Then we decided to perform this trial,
DECISION QFR trial to investigate the feasibility
of QFR
as a physiological information in heart team discussion
determining the optimal treatment strategy.
The patient population and the study design
is that we included the
260 chronic coronary syndrome patients,
with multivessel disease
including the proximal LAD lesion,
and as well for the revascularization,
we generated from each patient
both the QFR-based information
and FFR-based information.
Then the two heart teams were randomised to either
the QFR-based information or FFR-based patient information.
Then determine, then have a virtual heart team discussion
and determine their optimal treatment strategy
regarding the revascularization.
The primary endpoint of the study was level
of the agreement of the QFR-based treatment recommendation
with the FFR-based treatment recommendation,
as a reference.
The main result
of this study
was the agreements
between the two heart teams approach, QFR approach.
And the FFR approach was observed
in 91.5% of the cases,
as a primary endpoint, the Cohen's K was 0.73.
While the 95% confidence interval
was 0.62
to 0.83.
Their assumption of the Cohen's K was 0.60,
while the lower boundary
of the 95% confidence interval was 0.40 ,
therefore and this trial met the precipice
by the primary endpoints.
And we compared
the QFR measurement procedure time
and FFR measurement procedure time,
in this secondary endpoint,
the QFR achieved the shorter procedure time
compared to the FFR procedure time.
The key take-home message from this trial is the
the heart team decision making based on QFR
demonstrated the substantial agreement
with the one based on the FFR in patient
with multivessel of disease.
In this study,
we conclude that QFR
potentially increased the practicability
of the physiology guided decision making
in the heart team discussion
determining their optimal treatment revascularization.
For further study we need the outcome study
because the current study doesn't have the
the outcome after the decision making.