- Hi, my name is Simone Biscaglia from Ferrara University Hospital, in Italy. And today I will talk to you about the AQVA Trial, that is a randomised clinical trial, comparing virtual PCI based on QFR versus Angio-guided PCI.
Reasoning for This Study
So, the reasoning behind our study is pretty simple, because we know that Post-PCI physiology is related to outcome, but, it's not measured during clinical practice. And especially, it's not known what to do after a Suboptimal physiological PCI results. On the other hand, the quantitative flow ratio. So, an Angio-Based Fractional Flow Reserve estimation could be easily managed to perform a virtual PCI plan beforehand and not after PCI in order to improve the Post-PCI physiological value. And this was actually what we tested in the AQVA Trial.
Study Design and Patient Population
As for the study design, we conducted a randomised clinical trial on 300 patient and 356 vessels in two different centres. And as for the study population, the major inclusion criteria for the, was the indication for PCI, for either ACS or CCS. And obviously we had some exclusion criteria meaning features limiting QFR computation, culprit lesion on ACS and the impossibility to acquire good projections for QFR.
Outcomes
So, the primary outcome of the study was actually the superiority of the virtual PCI plan based on QFR if compared to the Angio-based PCI, in terms of the rate of suboptimal Post-PCI physiology, that was measured with the Post-PCI blended QFR at the core lab. So basically what we, what we showed is that in the virtual PCI plan, we had just less than 5% of patient with suboptimal Post-PCI physiology. Whereas in the Angio-guided arm, we have around 15%. So, this was a significant reduction of the primary endpoint As for the main secondary endpoint, We did not show any important and significant differences among the two arms as for length of the procedure, number of stent implanted, stent length, albeit we showed a little bit higher Delta QFR so improvement in the QFR value between pre and post PCI in the virtual PCI arm and a slightly longer procedure in the virtual PCI arm of just a couple, a couple of minutes.
Impact on Clinical Practice
So, I think that the translation in clinical practice is quite simple because we know that Angiography is not enough and the results of our procedure, are procedures that are angiographically good for us that they are actually not good for the patient. So, we have to try to use these new techniques which are helpful just to achieve the best, the best possible results in each patient. And I think that this is the take home message of the AQVA trial.
Further Study Required
I think that the next step should be to test whether this strategy is able to improve the outcome and not only the Post-PCI physiological results if compared to Angiography-guided PCI. Because in this case, I think that our practice should really change in all patients undergoing PCI.
EuroPCR 2022: Late-breaking Science Video Collection
Published: 13 May 2022
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5m 52sPart 2 | Session 12 EuroPCR 22: MitraClip in Atrial Functional Mitral Regurgitation
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2m 15sPart 2 | Session 13 EuroPCR 22: SCB with Micro-Reservoir Technology in Coronary Lesions
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4m 46sPart 2 | Session 14 EuroPCR 22: FORWARD PRO Study Shows No Durability Issues After 3 Years
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4m 25sPart 2 | Session 15 EuroPCR 22: DEB & DES in the Treatment of Diffuse CAD
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3m 16sPart 2 | Session 16 EuroPCR 22: EASTBOURNE Registry indicates Satefy of Sirolimus-Coated Balloon
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4m 27sPart 2 | Session 17 EuroPCR 22: JenaValve TAVR System for the Treatment of Aortic Regurgitation
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20m 24sPart 1 | Session 1 EuroPCR 22 Late-breaking Science Preview Joost Daemen, Nicolas M Van Mieghem
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Overview
Our regular review series View from the Thoraxcenter hosted by Prof Nicolas Van Mieghem and Dr Joost Daemen (Thoraxcentre, Erasmus MC, Rotterdam, NL) provide a concise analysis of the late-breaking science trials and spotlight questions that could change treatment strategies in interventional cardiology.
Short, accessible Expert Interviews will be available with select faculty focusing on the results, applicability, and impact on future research.
More from this programme
Part 1
View from the Thoraxcenter
In this concise episode of View from the Thoraxcenter, Prof Nicolas Van Mieghem and Dr Joost Daemen (Thoraxcentre, Erasmus MC, Rotterdam, NL) offer their take on the most anticipated late-breaking science form EuroPCR 2022.
Part 2
Expert Interviews
Short, accessible Expert Interviews with select faculty focusing on the results, applicability, and impact on future research.
Faculty Biographies
Transcript