image: SCAI Scientific Sessions 2025
Credit: Society for Cardiovascular Angiography & Interventions
Washington, D.C. – May 1, 2025 – New findings from FAVOR III China Trial, presented today as late-breaking science at the Society for Cardiovascular Angiography & Interventions (SCAI) 2025 Scientific Sessions, showed that machine learning-based approach identify top 10 prognostic factors for predicting 2-year major adverse cardiovascular events (MACE) after Quantitative Flow Ratio (QFR)-guided Percutaneous Coronary Intervention (PCI) and therefore may improve individual risk prediction. For patients with pre-random PCI strategy changed, Left Circumflex artery (LCX) lesion and QFR grey-zone value in LCX take on greater importance for the prediction of 2-year MACE. Another subset of findings from the FAVOR III China Trial showed that pre-randomization declared treatment plan based on angiography alone, failed to identify flow-limiting disease correctly in approximately 31% of patients (70% had pre-randomization physiology-concordant plan), which was a predictable clinical entity by demographic and angiographic characteristics. The likelihood of achieving post-randomization physiology-concordant was greater with QFR guidance. Patients with post-randomization physiology-concordant had improved clinical outcomes during two-year follow-up.
Each year, more than two million PCIs are performed worldwide – but like any invasive procedure, they come with risks. To determine whether PCI is medically necessary, physicians assess a patient’s fractional flow reserve, which gauges how much a narrowed artery is restricting blood flow to the heart. This can be measured in two ways: through angiography, a traditional method that involves injecting contrast dye to visualize blockages, or through QFR, a novel, non-invasive technique that analyzes imaging to blood flow reduction.
The FAVOR III China trial, a multicenter, randomized, sham-controlled trial conducted at Fuwai Hospital in Beijing, China, explores the long-term outcomes of PCI procedures guided by QFR. Hao-Yu Wang, MD, PhD, FSCAI, FACC, on behalf of the FAVOR III China trial team, conducted two post-hoc analyses, which focused on identifying the likelihood of MACE two years after treatment and highlights the potential benefits of using physiological assessments to guide PCI treatment decisions.
In the first subset of the FAVOR III trial, Hao-Yu Wang and researchers explored the impact of using physiological assessments – such as QFR – to guide treatment decisions aimed at restoring blood flow. Before treatment, physicians identified which blood vessels would receive PCI as part of a pre-randomization treatment plan. Patients were randomly assigned to either the QFR-guided or angiography-guided procedure group. Following treatment, researchers retrospectively evaluated both the original plans and final procedures using QFR to determine whether they aligned with physiological measurements.
Results showed that patients whose treatment strategies were aligned with physiology—particularly those guided by QFR—experienced fewer MACE. Specifically, the QFR-guided group with physiology-concordant plans had a primary MACE rate of 8.9%, compared to 10.4% in the angiography-guided group with physiology-concordant plans. Among patients whose original treatment plans were not physiologically concordant, only 7.6% in the QFR-guided group experienced MACE, compared to 17% in the angiography-guided group. Furthermore, across all patients, those whose final treatment strategies matched physiological assessments had a lower two-year MACE rate than those whose treatments did not (8.8% vs. 17.2%).
In another subset of the FAVOR III trial, Hao-Yu Wang and researchers developed a machine learning prognostic model for identifying the clinical, angiographic, and procedural features of patients likely to have 2-year MACE despite online QFR-guided PCI. Researchers developed a machine learning-based prognostic model to identify which clinical characteristics are most strongly associated with the risk of MACE two years after QFR-guided PCI. Using data from 1,913 patients, researchers tested eight different machine learning algorithms, each trained on 47 clinical features, to predict the likelihood of two-year MACE.
Findings revealed that 161 patients (8.4%) experienced MACE within two years of QFR-guided PCI. Among all variables examined, Estimated Glomerular Filtration Rate (eGFR) emerged as the strongest predictor, followed by stent length, body mass index (BMI), age, Left Ventricular Ejection Fraction (LVEF), anatomic SYNTAX score, lesion length, and history of PCI. Notably, in a subset of 375 patients whose planned PCI was deferred, researchers identified the lesion location involves LCX as the most significant risk factor for future events.
“The FAVOR III trial continues to provide valuable information that encourages prioritization of personalized treatments for patients and the use of artificial intelligence,” said Hao-Yu Wang, MD, PhD, FSCAI, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, in Beijing, China and lead author of the study. “By identifying key risk factors like kidney function, BMI, LVEF, and lesion location involves LCX, we’re moving towards better predicting and preventing heart complications after PCI."
“Findings from the FAVOR III trial show that when physicians use advanced tools like QFR to guide treatment, patients have better outcomes. We anticipate that more physicians will continue to use QFR in addition to implementing physiology-aligned plans to minimize the life-changing consequences that are associated with PCI,” said Hao-Yu Wang, MD, PhD, FSCAI, FACC, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, in Beijing and lead author of the study.
We expect these two studies to be published soon.
Session Details:
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Friday, May 2, 2025; 11:25-11:33 AM ET
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Walter E. Washington Convention Center, Hall D, Theater 4
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Thursday, May 1, 2025; 11:07-11:15 AM
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Walter E. Washington Convention Center, SCAI Central, Hall D
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About Society for Cardiovascular Angiography & Interventions (SCAI)
The Society for Cardiovascular Angiography & Interventions, established in 1978, stands as the primary nonprofit medical society dedicated to representing invasive and interventional cardiology. SCAI's mission is to guide the global interventional cardiovascular community by fostering education, advocacy, research, and upholding standards for quality patient care. For more than 40 years, SCAI has exemplified professional excellence and innovation worldwide, cultivating a reputable community of over 5,000 members committed to advancing medical science and providing life-saving care for individuals, both adults and children, affected by cardiovascular disease. For more information, visit https://scai.org/.
For more information about the SCAI 2025 Scientific Sessions, visit https://scai.org/scai-2025-scientific-sessions. Follow @SCAI on X for the latest heart health news and use #SCAI2025 to follow the latest discussions.