A Prospective Multicenter Real-World Registry of Quantitative Flow Ratio-Guided Coronary REvascularization and QuAlity evaLuation

NCT07766434 — Recruiting, 10000 participants, China National Center for Cardiovascular Diseases

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RegistryNCT07766434, acronym QFR-REAL
StatusRecruiting
Study typeObservational
Enrollment10000 (Estimated)
SponsorChina National Center for Cardiovascular Diseases (Other gov); collaborators: Guangdong Provincial People's Hospital, First Affiliated Hospital Xi'an Jiaotong University, Sir Run Run Shaw Hospital, Fuwai Huazhong Cardiovascular Hospital, Fuwai Yunnan Cardiovascular Hospital, Second Hospital of Jilin University
ConditionsCoronary Artery Disease
Datesstart 2026-08-26, primary completion 2028-07-01 (estimated), completion 2029-07-01 (estimated), first posted 2026-08-14, last updated 2026-09-24
Locations1 site in China

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-Summary

This prospective, multicenter observational registry aims to establish a QFR-based quality control standard system for coronary revascularization in patients with coronary artery disease. The study will enroll over 10,000 patients with visually estimated at least one main branch coronary stenosis ≥50% from more than 50 centers across China (covering provincial, municipal, and county-level hospitals). Coronary angiographic images and intracoronary imaging (if available) will be collected and retrospectively analyzed by an independent core laboratory. The primary endpoint is QFR acquisition accessibility, defined as the mean of QFR usage proportion across centers.

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+Detailed description

This is a prospective, multicenter, observational registry study conducted at more than 50 centers across China. Patients with coronary angiography showing visually estimated at least one main branch stenosis ≥50% who undergo PCI or receive conservative treatment for acute coronary syndrome (including unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction >4 weeks after onset) or chronic coronary syndrome (including stable angina and asymptomatic myocardial ischemia) will be consecutively enrolled. Coronary angiographic images will be submitted to an independent core laboratory for retrospective QFR analysis. The study will establish a QFR-based quality control standard system for coronary revascularization.

Prespecified subgroup analyses will be performed to assess the concordance rates, overtreatment, and undertreatment rates between clinical decisions and offline core laboratory QFR, and to explore heterogeneity across hospital levels, clinical presentations, disease complexity, target vessel, operator annual PCI volume, QFR image analyzability, and lesion morphology. Other prespecified subgroups will be analyzed for the primary and secondary endpoints, including age, sex, diabetes, smoking status, acute coronary syndrome, body mass index, left ventricular ejection fraction, lesion location, length and reference vessel diameter, stenosis severity, multivessel disease, calcified lesion, bifurcation, tandem and bending/tortuous lesion, QFR gray zone (0.75-0.85), QFR based functional and residual functional SYNTAX score, residual QFR, center experience for invasive physiology, and learning experience with QFR.

+Outcome measures

Primary outcomes

  • QFR Adoption Rate [At enrollment (baseline)]: Defined as the mean across participating centers of the proportion of patients undergoing QFR assessment among eligible patients at each center.

Secondary outcomes

  • MACE [6 month, 1 year, 3 years, and 5 years]: A composite of all-cause mortality, any myocardial infarction and any ischemia-driven revascularization
  • Death [6 months, 1 year, 3 years, and 5 years]: Cardiovascular, non-cardiovascular and undetermined death
  • MI [6 months, 1 year, 3 years, and 5 years]: Target vessel related and non-target vessel related MI
  • Target vessel revascularization (TVR) [6 months, 1 year, 3 years, and 5 years]: The ischemia driven and non-ischemia driven TVR
  • Any coronary artery revascularization [6 months, 1 year, 3 years, and 5 years]: The ischemia driven and non-ischemia driven Revascularization
  • Definite or probable stent thrombosis [6 months, 1 year, 3 years, and 5 years]: Definite and probable stent thrombosis during acute, sub-acute, late, and very late phase according to the Academic Research Consortium (ARC)-2

+Eligibility

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Age ≥18 years
* Coronary angiography showing visually estimated at least one main branch coronary stenosis ≥50% in patients with acute coronary syndrome (including unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction >4 weeks after onset) or chronic coronary syndrome (including stable angina and asymptomatic myocardial ischemia) who undergo PCI or receive conservative treatment
* Ability to understand the study design and provide written informed consent

Exclusion Criteria:

* ST-segment elevation myocardial infarction within 4 weeks of onset
* History of coronary artery bypass grafting (CABG) or planned CABG within 6 months
* Inability to undergo coronary angiography
* Non-cardiac cause with expected survival <1 year
* Other conditions that may interfere with follow-up (e.g., dementia, substance abuse including drug addiction and other drug dependencies)
* Refusal to participate in the study

+Locations (1)

FacilityCityCountryStatus
National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, Beijing MunicipalityChinaRecruiting

+Publications

  • Zhang R, Wang HY, Song L, Guan C, Yin D, Zhu C, Feng L, Jin Z, Yu B, Fu G, Zhou Y, Wang J, Chen Y, Pu J, Chen L, Qu X, Zhao Y, Wang Y, Liu W, Qiao S, Tu S, Wijns W, Dou K; FAVOR III China Study Group. Rationales Behind Physiology-Guided Revascularization: Diagnostic Impact of Quantitative Flow Ratio in the FAVOR III China Trial. JACC Cardiovasc Interv. 2026 Feb 23;19(4):422-434. doi: 10.1016/j.jcin.2025.10.042. Epub 2025 Nov 20. PMID 41263729
  • Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, Banning AP, Budaj A, Buechel RR, Chiariello GA, Chieffo A, Christodorescu RM, Deaton C, Doenst T, Jones HW, Kunadian V, Mehilli J, Milojevic M, Piek JJ, Pugliese F, Rubboli A, Semb AG, Senior R, Ten Berg JM, Van Belle E, Van Craenenbroeck EM, Vidal-Perez R, Winther S; ESC Scientific Document Group. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024 Sep 29;45(36):3415-3537. doi: 10.1093/eurheartj/ehae177. No abstract available. PMID 39210710
  • Xu B, Tu S, Song L, Jin Z, Yu B, Fu G, Zhou Y, Wang J, Chen Y, Pu J, Chen L, Qu X, Yang J, Liu X, Guo L, Shen C, Zhang Y, Zhang Q, Pan H, Fu X, Liu J, Zhao Y, Escaned J, Wang Y, Fearon WF, Dou K, Kirtane AJ, Wu Y, Serruys PW, Yang W, Wijns W, Guan C, Leon MB, Qiao S, Stone GW; FAVOR III China study group. Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial. Lancet. 2021 Dec 11;398(10317):2149-2159. doi: 10.1016/S0140-6736(21)02248-0. Epub 2021 Nov 4. PMID 34742368
  • Xu B, Tu S, Qiao S, Qu X, Chen Y, Yang J, Guo L, Sun Z, Li Z, Tian F, Fang W, Chen J, Li W, Guan C, Holm NR, Wijns W, Hu S. Diagnostic Accuracy of Angiography-Based Quantitative Flow Ratio Measurements for Online Assessment of Coronary Stenosis. J Am Coll Cardiol. 2017 Dec 26;70(25):3077-3087. doi: 10.1016/j.jacc.2017.10.035. Epub 2017 Oct 31. PMID 29101020