Skip to main content
OpenTrials
Active, Not Recruiting

NCT Number: NCT03729739

Functional Assessment by Virtual Online Reconstruction. The FAVOR III Europe Trial

Quantitative Flow Ratio (QFR) is a novel method for evaluating the functional significance of coronary stenosis. QFR is estimated based on two angiographic projections. Studies have shown a good correlation with the present wire-based standard approach Fractional Flow Reserve (FFR) for assessment of intermediate coronary stenosis. The purpose of the FAVOR III Europe Japan study is to investigate if a QFR-based diagnostic strategy will results in non-inferior clinical outcome after 12 months compared to a standard pressure-wire guided strategy in evaluation of patients with chest pain (stable angina pectoris) and intermediate coronary stenosis.

Active, Not Recruiting

This study is active but is not currently recruiting participants.

Key information

Conditions

Coronary Artery Disease Angina Pectoris Arterial Occlusive Diseases Arteriosclerosis Cardiovascular Diseases Chest Pain Coronary Disease Heart Diseases Myocardial Ischemia Neurologic Manifestations Pain Pathological Conditions, Signs and Symptoms Signs and Symptoms Vascular Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Aalborg University Hospital, Aalborg, Denmark

Loading trial locations.

About this study

Patients at high risk of having one or more coronary stenosis are evaluated routinely by invasive coronary angiography (CAG). Lesions are often quantified by visual assessment of the angiogram, but physiological assessment of the functional significance by fractional flow reserve has been shown to improve clinical outcome, to reduce number of stents implanted, and has obtained the highest recommendation in European guidelines. FFR is assessed during CAG by advancing a wire with a pressure transducer towards the stenosis and measure the ratio in pressure between the two sides of the stenosis during medical induced maximum blood flow (hyperaemia).

The solid evidence for FFR evaluation of coronary stenosis and the relative simplicity in performing the measurements have supported adoption of an FFR based strategy but the need for interrogating the stenosis by a pressure wire, the small risks associated hereto, the cost of the wire, and the drug inducing hyperaemia has limited more widespread adoption.

Quantitative Flow Ratio is a novel method for evaluating the functional significance of coronary stenosis by calculation of the pressure drop in the vessel based on computation of two angiographic projections.

Two multi-center studies, the FAVOR II Europe-Japan and China studies evaluated the feasibility and diagnostic performance of in-procedure QFR, showing very good agreement between QFR and FFR.

The purpose of the FAVOR III Europe Japan study is to investigate if a QFR-based diagnostic strategy yields non-inferior 12-month clinical outcome compared to a standard pressure-wire guided strategy in evaluation of patients with stable angina pectoris and intermediate coronary stenosis.

Primary hypothesis: A QFR based diagnostic strategy results in non-inferior clinical outcome, assessed by a composite endpoint of all cause death, non-fatal myocardial infarction (MI) and unplanned revascularization after one year, compared to a strategy of pressure wire-based FFR for assessment of physiological significance of intermediate coronary artery stenosis.

Methods: Investigator initiated, 1:1 randomized, prospective, clinical outcome, non-inferiority, multi-center trial performed at up to 40 international sites with inclusion of 2000 patients.

Patients with stable angina pectoris or need for evaluation of non-culprit lesions after acute MI are enrolled. At least two angiographic projections are acquired during resting conditions. If the angiographic criteria are met, the patient is randomized to either a QFR- or an FFR-based diagnostic strategy.

Revascularization is performed according to best standard by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).

Patient follow-up is continued until 24 months.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age of 18 years and above
  • Both genders
  • Indication for invasive coronary angiography
  • Patients with stable angina pectoris, or assessment of secondary lesions in stabilized non-STEMI patients or assessment of secondary lesions in patients with prior STEMI and staged evaluation of secondary lesions.
  • Able to provide written informed consent

Angiographic inclusion criteria

  • Diameter stenosis of 40-90% diameter stenosis
  • Vessel diameter of at least 2.5 mm and supplying viable myocardium
  • Patients with restenosis in a native coronary artery can be included

Exclusion criteria

  • Severely impaired renal function: Glomerular filtration rate (GFR) < 20 mL/min/1.73m²
  • Life expectancy less than one year
  • Cardiogenic shock or unstable haemodynamic state (Killip class III and IV)
  • ST-elevation myocardial infarction (STEMI) within 24 hours
  • Bypass graft to any target vessel
  • Atrial fibrillation at the time of the procedure
  • Chronic total occlusions of any vessel with possible or established indication for treatment
  • Pregnancy or intention to become pregnant during the course of the trial
  • Breast feeding
  • Planned need for concomitant valvular or aortic surgery
  • Left ventricular ejection fraction (LVEF) < 30%
  • Previous inclusion in the FAVOR III trial
  • Enrolled in another clinical study, and for this reason not treated according to present European Society of Cardiology guidelines, or the protocol treatment conflicts with the protocol treatment of FAVOR III
  • Inability to tolerate contrast media
  • Inability to tolerate Adenosine

Angiographic exclusion criteria

  • Ostial right coronary artery > 50% diameter stenosis
  • Left main coronary artery > 50% diameter stenosis
  • Lesions properties indicative of myocardial bridging
  • Bifurcation lesions with major (>1 mm) step down in reference size across the bifurcation
  • Severe tortuosity of any target vessel
  • Severe overlap in the stenosed segment
  • Poor image quality precluding identification of vessel contours

Treatment and study plan

QFR-based diagnostic strategy

Diagnostic Test

Novel computer based calculation of lesion severity. Pressure wire-free and adenosine-free

FFR-based diagnostic strategy

Diagnostic Test

Standard FFR based diagnostic method. Pressure drop across the stenosis is measured with a pressure wire during medical induced hyperaemic conditions

Primary outcomes

  1. Patient oriented composite endpoint (PoCE)

    Time frame: 12 months

    A composite endpoint of 1) all-cause mortality, 2) any myocardial infarction, and 3) any unplanned revascularization

Secondary outcomes

  1. Target vessel failure

    Time frame: 1 month

    A composite of cardiac death, target vessel myocardial infarction and ischemic driven target vessel revascularization.

  2. Target vessel failure

    Time frame: 12 months

    A composite of cardiac death, target vessel myocardial infarction and ischemic driven target vessel revascularization.

  3. Target vessel failure

    Time frame: 24 months

    A composite of cardiac death, target vessel myocardial infarction and ischemic driven target vessel revascularization.

  4. All-cause mortality

    Time frame: 1 month

    Total death includes cardiac death and other fatal categories such as cerebrovascular death, death from other cardiovascular disease (i.e. pulmonary embolism, dissection aortic aneurism will be included in this category), death from malignant disease, death from suicide, violence or accident, or death from other reasons.

  5. All-cause mortality

    Time frame: 12 months

    Total death includes cardiac death and other fatal categories such as cerebrovascular death, death from other cardiovascular disease (i.e. pulmonary embolism, dissection aortic aneurism will be included in this category), death from malignant disease, death from suicide, violence or accident, or death from other reasons.

  6. All-cause mortality

    Time frame: 24 months

    Total death includes cardiac death and other fatal categories such as cerebrovascular death, death from other cardiovascular disease (i.e. pulmonary embolism, dissection aortic aneurism will be included in this category), death from malignant disease, death from suicide, violence or accident, or death from other reasons.

  7. Cardiac death

    Time frame: 1 month

    Encompasses death due to coronary heart disease including fatal myocardial infarction, sudden cardiac death including fatal arrhythmias and cardiac arrest without successful resuscitation, death from heart failure including cardiogenic shock, and death related the cardiac procedure within 28 days from the procedure. If death is not clearly attributable to other non-cardiac causes it is adjudicated as cardiac death

  8. Cardiac death

    Time frame: 12 months

    Encompasses death due to coronary heart disease including fatal myocardial infarction, sudden cardiac death including fatal arrhythmias and cardiac arrest without successful resuscitation, death from heart failure including cardiogenic shock, and death related the cardiac procedure within 28 days from the procedure. If death is not clearly attributable to other non-cardiac causes it is adjudicated as cardiac death

  9. Cardiac death

    Time frame: 24 months

    Encompasses death due to coronary heart disease including fatal myocardial infarction, sudden cardiac death including fatal arrhythmias and cardiac arrest without successful resuscitation, death from heart failure including cardiogenic shock, and death related the cardiac procedure within 28 days from the procedure. If death is not clearly attributable to other non-cardiac causes it is adjudicated as cardiac death

  10. Myocardial infarction

    Time frame: 1 month

    Procedure and non-procedure related myocardial infarction. Protocol defined.

  11. Myocardial infarction

    Time frame: 12 months

    Procedure and non-procedure related myocardial infarction. Protocol defined.

  12. Myocardial infarction

    Time frame: 24 months

    Procedure and non-procedure related myocardial infarction. Protocol defined.

  13. Target vessel myocardial infarction

    Time frame: 1 month

    As "any myocardial infarction", but with culprit lesion in index vessel.

  14. Target vessel myocardial infarction

    Time frame: 12 months

    As "any myocardial infarction", but with culprit lesion in index vessel.

  15. Target vessel myocardial infarction

    Time frame: 24 months

    As "any myocardial infarction", but with culprit lesion in index vessel.

  16. Any unplanned revascularization

    Time frame: 1 month

    Coronary artery bypass grafting (CABG) or PCI of any lesion.

    Planned Revascularization:

    Revascularization is considered planned when it is decided at the time of the index procedure, based on the results of angiography and functional testing. Planned revascularization could be performed at the time of the index procedure or within 60 days. Such revascularization is considered as "primary" revascularization and is not considered as an endpoint. The "planned" status of the revascularization is adjudicated.

    Unplanned Revascularization:

    Revascularization is considered "unplanned" when not performed as part of standard care during the index procedure or if it is not planned as a staged procedure to occur within 60 days.

  17. Any unplanned revascularization

    Time frame: 12 months

    Coronary artery bypass grafting (CABG) or PCI of any lesion.

    Planned Revascularization:

    Revascularization is considered planned when it is decided at the time of the index procedure, based on the results of angiography and functional testing. Planned revascularization could be performed at the time of the index procedure or within 60 days. Such revascularization is considered as "primary" revascularization and is not considered as an endpoint. The "planned" status of the revascularization is adjudicated.

    Unplanned Revascularization:

    Revascularization is considered "unplanned" when not performed as part of standard care during the index procedure or if it is not planned as a staged procedure to occur within 60 days.

  18. Any unplanned revascularization

    Time frame: 24 months

    Coronary artery bypass grafting (CABG) or PCI of any lesion.

    Planned Revascularization:

    Revascularization is considered planned when it is decided at the time of the index procedure, based on the results of angiography and functional testing. Planned revascularization could be performed at the time of the index procedure or within 60 days. Such revascularization is considered as "primary" revascularization and is not considered as an endpoint. The "planned" status of the revascularization is adjudicated.

    Unplanned Revascularization:

    Revascularization is considered "unplanned" when not performed as part of standard care during the index procedure or if it is not planned as a staged procedure to occur within 60 days.

  19. Any ischemia driven de novo revascularization

    Time frame: 1 month

    Coronary artery bypass grafting or PCI of a vessel that was not evaluated nor treated during the index procedure. In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI

  20. Any ischemia driven de novo revascularization

    Time frame: 12 months

    Coronary artery bypass grafting or PCI of a vessel that was not evaluated nor treated during the index procedure. In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI

  21. Any ischemia driven de novo revascularization

    Time frame: 24 months

    Coronary artery bypass grafting or PCI of a vessel that was not evaluated nor treated during the index procedure. In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI

  22. Ischemia driven target vessel revascularization

    Time frame: 1 month

    Coronary artery bypass grafting (CABG) or PCI of a study vessel with documented ischemia. In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI

  23. Ischemia driven target vessel revascularization

    Time frame: 12 months

    Coronary artery bypass grafting (CABG) or PCI of a study vessel with documented ischemia. In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI

  24. Ischemia driven target vessel revascularization

    Time frame: 24 months

    Coronary artery bypass grafting (CABG) or PCI of a study vessel with documented ischemia. In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI

  25. Ischemia driven treated target lesion revascularization

    Time frame: 1 month

    Coronary artery bypass grafting (CABG) or PCI of a study vessel with documented ischemia that was treated during index or planned staged procedure. In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI

  26. Ischemia driven treated target lesion revascularization

    Time frame: 12 months

    Coronary artery bypass grafting (CABG) or PCI of a study vessel with documented ischemia that was treated during index or planned staged procedure. In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI

  27. Ischemia driven treated target lesion revascularization

    Time frame: 24 months

    Coronary artery bypass grafting (CABG) or PCI of a study vessel with documented ischemia that was treated during index or planned staged procedure. In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI

  28. Ischemia driven, measured segment revascularization

    Time frame: 1 month

    Coronary artery bypass grafting (CABG) or PCI of a study vessel that was evaluated by either FFR or QFR but not treated. In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI.

  29. Ischemia driven, measured segment revascularization

    Time frame: 12 months

    Coronary artery bypass grafting (CABG) or PCI of a study vessel that was evaluated by either FFR or QFR (both treated and not treated). In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI.

  30. Ischemia driven, measured segment revascularization

    Time frame: 24 months

    Coronary artery bypass grafting (CABG) or PCI of a study vessel that was evaluated by either FFR or QFR but not treated. In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI.

  31. Ischemia driven measured segment de novo revascularization

    Time frame: 1 month

    Coronary artery bypass grafting (CABG) or PCI of a study vessel that was evaluated by either FFR or QFR but not treated. In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI.

  32. Ischemia driven measured segment de novo revascularization

    Time frame: 12 months

    Coronary artery bypass grafting (CABG) or PCI of a study vessel that was evaluated by either FFR or QFR but not treated. In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI.

  33. Ischemia driven measured segment de novo revascularization

    Time frame: 24 months

    Coronary artery bypass grafting (CABG) or PCI of a study vessel that was evaluated by either FFR or QFR but not treated. In stable patients, ischemia should always be documented, using for example FFR, SPECT scan or MRI.

  34. Feasibility of QFR

    Time frame: 1 hour

    Percentage of successful QFR in patients allocated to a QFR based diagnostic strategy

  35. Feasibility of FFR

    Time frame: 1 hour

    Percentage of successfully performed FFR measurements in vessels with attempted FFR (vessel level) Percentages of patients with successful FFR measurements (all attempted)

  36. Number of lesion interrogated

    Time frame: 1 hour

    Total number of lesions diagnosed with either QFR or FFR during the procedure

  37. Procedure time

    Time frame: 1 hour

    Time from introduction of the sheet until the sheet for coronary access is removed from the patient

  38. Contrast volume

    Time frame: 1 hour

    Total volume of contrast used in the procedure

  39. Fluoroscopy time

    Time frame: 1 hour

    Total fluoroscopy time for the procedure

  40. Number of stents implanted

    Time frame: 1 hour

    Total number of stents implanted during the procedure. Stents implanted in a staged procedure are included

Sponsors and collaborators

Lead sponsor

Aarhus University Hospital Skejby

Other

Collaborators

  • Medis Medical Imaging Systems

Registry information

Official study title

Comparison of Quantitative Flow Ratio (QFR) and Conventional Pressure-wire Based Functional Evaluation for Guiding Coronary Intervention. A Randomized Clinical Non-inferiority Trial

Important dates

Study start
2018
Primary completion
2023
Study completion
2025
First posted
Nov 5, 2018
Registry last updated
Jul 24, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Related clinical trials

Published trials that share one or more normalized conditions with this study.