Residual global μQFR assessment associated with 3-year MACE risk in acute coronary syndrome patients

Photo by Markus Spiske / Unsplash

JACC. Cardiovascular interventions Published April 16, 2026 Medically reviewed May 1, 2026 Study authors: Shen Xiaohua, Zhang Han, Li Zhengwei, Guan Changdong, Jin Chongying, Jin Zening, Yu Bo, Zhou Yujie, … PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider residual global μQFR for risk stratification in ACS, noting the post hoc design limits causal conclusions.

This study represents a post hoc analysis of a randomized controlled trial involving 2,428 acute coronary syndrome patients. The population included individuals with ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, or unstable angina. Participants underwent residual global μQFR assessment to stratify risk into high-risk versus low-risk groups.

Over a follow-up duration of 36.0 months, the primary outcome of 3-year major adverse cardiac events occurred in 21.2% of the high-risk group compared to 10.4% in the low-risk group among n = 407 high-risk patients. This difference yielded an adjusted HR of 1.53 with a 95% CI: 1.10-2.13; P = 0.01. When excluding periprocedural myocardial infarction, 3-year MACE rates were 16.2% versus 7.8%, respectively, with an adjusted HR of 1.72 (95% CI: 1.17-2.53; P = 0.006).

In patients with low residual ischemia, QFR-guided PCI was associated with 8.8% MACE versus 11.9% for angiography-guided PCI (HR: 0.73; 95% CI: 0.55-0.97). Safety data regarding adverse events, serious adverse events, and discontinuations were not reported. The primary limitation is the post hoc analysis design, which restricts causal inference.

While residual global μQFR appears to be a robust angiographic index for long-term risk stratification, the evidence remains associative. Clinicians should recognize that these results reflect associations rather than proven causation regarding intervention efficacy.

Study Details

Study typeRct

Sample sizen = 407

EvidenceLevel 2

Follow-up36.0 mo

PublishedApr 2026

PMID41986039

View Original Abstract ↓

BACKGROUND: The prognostic utility of residual pressure wire-based physiological assessment after percutaneous coronary intervention (PCI) has been demonstrated. OBJECTIVES: The aim of this study was to investigate the prognostic value of the residual global Murray law-based angiographic quantitative flow ratio (μQFR) in an acute coronary syndrome (ACS) population. METHODS: In this post hoc analysis from the FAVOR III China (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients With Coronary Artery Disease) trial, off-line μQFR was computed for 3 major coronary arteries. Residual global μQFR was calculated as the sum of postprocedural μQFR values for treated vessels and preprocedural values for nontreated vessels. ACS patients (including those with ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, and unstable angina) were categorized into high-risk (less than or equal to the cutoff value) and low-risk (greater than the cutoff value) groups according to residual global μQFR. The primary endpoint was 3-year major adverse cardiac events (MACE), the composite of all-cause death, myocardial infarction, or ischemia-driven revascularization. RESULTS: Among 2,428 ACS patients, 2,241 (92.3%) had analyzable μQFR, with a cutoff value of 2.71. High-risk patients (n = 407 [18.2%]) had a greater incidence of 3-year MACE (21.2% vs 10.4%; adjusted HR [aHR]: 1.53; 95% CI: 1.10-2.13; P = 0.01) and MACE excluding periprocedural myocardial infarction (16.2% vs 7.8%; aHR: 1.72; 95% CI: 1.17-2.53; P = 0.006) compared with the low-risk group. The prognostic effect of residual global μQFR was consistent across QFR- and angiography-guided subgroups (P for interaction = 0.35). Patients with low residual ischemia derived the best outcomes after QFR-guided PCI (MACE 8.8% vs 11.9% for angiography-guided PCI; HR: 0.73; 95% CI: 0.55-0.97). CONCLUSIONS: Residual global μQFR is a robust angiographic index for post-PCI ischemia burden and long-term risk stratification. In patients with ACS, QFR-guided PCI achieving low residual global ischemia was associated with the most favorable 3-year prognosis.