03 aimradial2016 thu M Mamas

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International Chair on Interventional Cardiology and Transradial Approach

This study examined whether increased use of radial artery access for PCI procedures in the UK between 2006-2013 was associated with worse outcomes for femoral artery access procedures. The study found: 1) Centers that predominantly used radial access tended to reserve femoral access for higher risk patients, leading to initially worse femoral outcomes. 2) After adjusting for differences in patient risk, femoral outcomes were similar between high and low radial access centers. 3) There is no evidence that increased radial access led to decreased proficiency in femoral access or worse femoral outcomes in the UK, where 75% of PCI procedures now use radial access.

Increased radial access is not associated
with worse femoral outcomes for PCI in the
United Kingdom
Mamas Mamas
Professor of Cardiology
Keele Cardiovascular Research Group
Keele University, UK

Disclosure
I have no conflict of interest to declare

Radial 2005
Mamas et al. Circulation. 2016;133(17):1655-67.

Radial 2006
Mamas et al. Circulation. 2016;133(17):1655-67.

Radial 2007
Mamas et al. Circulation. 2016;133(17):1655-67.

Radial 2008
Mamas et al. Circulation. 2016;133(17):1655-67.

Radial 2009
Mamas et al. Circulation. 2016;133(17):1655-67.

Radial 2010
Mamas et al. Circulation. 2016;133(17):1655-67.

Radial 2011
Mamas et al. Circulation. 2016;133(17):1655-67.

Radial 2012
Mamas et al. Circulation. 2016;133(17):1655-67.

Estimated 450 lives “saved” by change in practice
Estimated 264 lives “lost” by failure to adopt practice across the board

Background
• Even in high volume TRA centres, situations where
PCI needs to be undertaken in TFA between 5-10% of
cases (Abdelaal et al. JACC. Card interven. 2013, Uddin et al. J Interv Cardiol. 2015 )
• Concerns that transition to TRA may compromise
TFA related outcomes.

• Comparison of Access site complications in 12,396 femoral
procedures compared between 1996-1998 and 2006-2008
Incident vascular complications

Aim
• To determine whether a change in access site practice
towards TRA at a centre level over time has led to
worse TFA outcomes
• To determine whether improved clinical outcomes
achieved by the national adoption of radial access are
attenuated by a loss of femoral proficiency

Methods
23/92 centres
16/92 centres
53/92 centres
2006 YEAR 2013
LowTFAProportionHigh
High FP centres > 66.7%
low FP centres < 33.6 %
Intermediate FP centres 33.6-66.6%

Methods
• Design Retrospective observational cohort study
• Data UK BCIS PCI registry
• Time period 2006 to 2013 (7 years)
• Cohort all femoral-only procedures in England and Wales
• Outcome 30-day mortality, vascular complications
• Exposure femoral experience - defined as the proportion of
femoral procedures performed by centre in 2013
• Confounders demographic, clinical, procedural factors and total
procedural volume
• Statistical modelling multiple logistic regression with
imputation for missing data

Differences in Practice at centre level
(92 centres, 230,755 femoral procedures)

Centres that remained femoral were
typically low volume
92 centres
230,755 femoral procedures

$• Demographic sex, age • Clinical indication (elective, UA/nSTEMI , STEMI), cardiogenic shock, respiratory support, circulatory support, previous MI, previous CABG, hypertension, hypercholesterolaemia, diabetes, renal function, smoking, left-ventricular ejection fraction • Procedural stent type (DES/ BMS), multi-vessel PCI, LMS PCI, GP IIb/IIIa inhibitor use • Institutional total procedural volume in previous 12 months Adjustment: Confounders$

Top 10 vs bottom 10 FP centres
Top 10 Radial centres in 2013; TRA proportion between 87.1 - 94.8%
Top 10 femoral centres in 2013; TFA proportion between 77.8 - 98.4%

“Non-Complex” Procedures (CS, circulatory
support and ventilation excluded)

Conclusion
• Poorer femoral outcomes for predominantly high radial centers
are driven by the tendency of these centers to utilize femoral
access in the highest risk patients.
• Once differences in case mix are adjusted for, femoral
outcomes are similar between high and low radial proportion
centers.
• No evidence to suggest “Campeau Paradox” in a country that
has transition to predominantly radial (75% of PCI radial)
• TRA should be default access site as per current evidence basis
/ international guidelines

This document discusses changes in access site practice in the UK with the transition to radial artery access for PCI procedures. It finds that centers that adopted a high rate of radial procedures did not have worse outcomes for the femoral procedures they continued to perform. After adjusting for differences in patient risk factors, femoral outcomes were similar between high and low radial proportion centers. There is no evidence that the widespread adoption of radial access across the UK led to compromised femoral outcomes at the center level. The transition to radial access appears to have realized reductions in mortality without negatively impacting outcomes for the femoral procedures still required in high-risk cases.

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Kidney stones are more common after bariatric surgery compared to obese patients who do not undergo surgery. The study examined over 750 patients who had bariatric surgery and matched them to obese controls. New stone formation was significantly higher after surgery (11.0%) versus controls (4.3%). The risk was highest with malabsorptive procedures (hazard ratio of 4.15) and standard gastric bypass (hazard ratio of 2.13). Malabsorptive procedures also increased the risk of chronic kidney disease (hazard ratio of 1.96). Urine tests showed stone formers after surgery had higher urine oxalate and calcium oxalate supersaturation levels compared to non-stone formers or obese controls

Oesophageal Doppler Stroke Volume Optimisation

javier.fabra

Intraoperative oesophageal Doppler monitoring (ODM) guided fluid management was compared to standard central venous pressure (CVP) guided fluids in a randomized controlled trial of 128 colorectal surgery patients. ODM guided fluid optimization resulted in significantly shorter hospital length of stay, earlier return of gut function, fewer postoperative complications, and cost savings compared to CVP-guided fluids. ODM provided a more reliable assessment of intravascular volume status and cardiac preload than CVP alone.

Oesophageal Doppler Stroke Volume Optimisation

fast.track

Oesophageal Doppler Monitoring (ODM) provides a non-invasive assessment of stroke volume and cardiac output during surgery. A randomized controlled trial found that using ODM to guide intraoperative fluid management in colorectal surgery patients resulted in shorter hospital length of stay, earlier return of gut function, fewer complications, better hemodynamic measurements, and cost savings compared to managing fluids to maintain CVP between 12-15 mmHg. ODM may help optimize fluid management and improve recovery in complex and orthopedic surgeries.

National Comparative Audit of Lower GI Bleeding

Dr Kathryn Oakland

This document summarizes the results of a national audit on lower gastrointestinal bleeding (LGIB) in the UK. It found that over 2528 patients were included from 139 hospitals. Key findings include that 26.7% of patients received red blood cell transfusions, but many transfusions may have been inappropriate. Nearly half of patients had no inpatient investigations to identify the bleeding source. Access to lower GI endoscopy and interventional radiology varied between hospitals. The audit recommendations focus on improving investigation of patients, guidelines for transfusion and management of anticoagulants, and increasing access to key services including interventional radiology.

Doctor James Doran

NACCHOpresentations

DVT PROPHYLAXIS IN ORTHOPAEDICS

Rohit Vikas

This document discusses deep vein thrombosis (DVT) prevention and management following total hip arthroplasty (THA) and total knee arthroplasty (TKA). It summarizes guidelines from the American College of Chest Physicians (ACCP) and the American Academy of Orthopaedic Surgeons (AAOS) on thromboprophylaxis. Key points include: - ACCP guidelines historically focused on DVT prevention and favored potent anticoagulants, but underestimated bleeding risks. AAOS advocated using symptomatic outcomes. - Concerns with ACCP included conflicts of interest, prohibiting less aggressive options, and lack of applicability to orthopedic patients. - 2012 ACCP guidelines addressed orthopedic

Endovenous or surgical treatment of cvi

uvcd

This document discusses various treatment options for chronic venous insufficiency (CVI), including endovenous ablation techniques (radiofrequency ablation (RFA) and endovenous laser ablation (EVLA)) and surgical treatment. It provides data on the increasing use of RFA and EVLA compared to surgery based on number of procedures performed in the US from 2002-2008. It summarizes evidence that RFA and EVLA provide similar clinical results as surgery with less post-operative pain, faster recovery times, and earlier return to normal activities. However, long-term data on recurrence rates beyond 3 years is still limited.

Salon 2 13 kasim 14.00 15.00 john albaran

tyfngnc

This document summarizes trends and developments in the management of acute coronary syndromes (ACS). It discusses improvements in pre-hospital care like early ECGs that aid diagnosis and direct transport to catheterization labs. In-hospital, point-of-care testing of biomarker panels can safely rule out heart attacks within 90 minutes and allow more patients to be discharged earlier from emergency departments. Adherence to guidelines for evidence-based medical therapies and quality improvement standards is associated with better outcomes for ACS patients.

Preventing DVT in Hospitalized Patients

MedicineAndHealthUSA

This document discusses methods for preventing deep vein thrombosis (DVT) in hospitalized patients. It describes risk factors for DVT including Virchow's triad of stasis, vessel injury, and hypercoagulability. Guidelines recommend different prophylaxis methods depending on patient risk factors and surgery type, including mechanical methods, anticoagulants, and combination approaches. Outcomes of interest include asymptomatic and symptomatic DVT and pulmonary embolism.

Kims presentation web edit

Inderpaul Birdi

This document discusses cardiac surgery services available at KIMS hospital. It provides details on the cardiac surgeons and their experience and training. Surgeries performed include CABG, valve repairs/replacements, and minimally invasive "keyhole" surgeries. The hospital has excellent infrastructure for cardiac surgery and diagnostic capabilities. Surgeons are consultant-led and provide daily ward rounds and multidisciplinary care. Outcomes data shows low risk-adjusted mortality rates. A variety of standard and specialized minimally invasive surgeries are available.

Using primary care databases to evaluate drug benefits and harms: are the res...

David Springate

Databases of electronic medical records and in particular primary care databases (PCDs) are increasingly used in research. The largest PCDs contain full data on all primary care consultations by millions of patients over two or more decades. They provide a means for investigating important healthcare questions which cannot be practically addressed in a Randomised Controlled Trial. However, concerns remain about the validity of studies based on data from PCDs. Most work around validity has attempted to confirm individual data values within a dataset. We take a different approach and instead replicate published PCD studies in a second, independent, PCD. Agreement of results then implies that the conclusions drawn are independent of the data source (though this doesn’t rule out that such as confounding by indication are commonly influencing both). We replicated two previous PCD studies using the Clinical Practice Research Datalink (CPRD). The first was a retrospective cohort study of the effect of Beta-blocker therapy on survival in cancer patients using DIN-LINK. The second was a nested case-control analysis of the effects of Statins on mortality of patients with ischaemic heart disease using QRESEARCH. Our analyses produced several important quantitative differences compared to the original studies, altering conclusions. These could not be fully explained by either demographic differences in the patient samples or structural differences between the datasets. Our study highlights both the caution that needs to be applied when assessing the findings from analysis of just a single database and the difficulties in performing replications of existing PCD studies.

Laparoscopic Liver Resection : What to do and not do - Pr Daniel CHERQUI

Centre Hepato-Biliaire / AP-HP Hopital Paul Brousse

Olivecrona GK et al.

International Chair on Interventional Cardiology and Transradial Approach

This document summarizes the results of a study analyzing outcomes of 21,000 STEMI patients who underwent primary PCI via either transradial or transfemoral access. The study found lower adjusted 30-day and 1-year mortality rates, as well as lower bleeding complications, in patients who received transradial access compared to transfemoral access. Younger patients and males experienced even greater mortality benefit from the transradial approach. While the results suggest potential survival benefits with transradial PCI, the authors call for a large randomized controlled trial to confirm whether this access method can reduce mortality.

Diabetic Foot Interventions

RavulJindal

Late Outcomes of Cord Blood Transplantation for Patients with Hurler Syndrome

cordbloodsymposium

Late Outcomes of Cord Blood Transplantation for Patients with Hurler Syndrome This study analyzed 197 patients with Hurler syndrome who underwent hematopoietic stem cell transplantation between 1980-2008. It found that event-free survival was highest for those receiving stem cells from an identical sibling or 6/6 cord blood match. Neurodevelopmental outcomes and risks of orthopedic complications were influenced by pre-transplant developmental status and enzyme levels post-transplant, indicating residual disease burden remains. Earlier transplantation and strategies to increase post-transplant enzyme levels may further optimize outcomes.

JASICON 2021 presentation ppt.pptx

SoumyajitJana7

This document summarizes a study assessing pre-operative outcomes and their correlation with intra-operative findings for laparoscopic cholecystectomies. It introduces cholelithiasis and laparoscopic cholecystectomy as the gold standard treatment. The study aims to evaluate factors that make laparoscopic cholecystectomy difficult. It employs a pre-operative scoring system based on patient history, exam, and ultrasound findings, and compares it to intra-operative scoring of difficulty. The results show a 91.5% correlation between pre-operative and intra-operative scores. Most pre-operative risk factors were significantly correlated with difficulty. The scoring system was found to reliably predict difficulty of laparoscopic cholecyst

Reunion Madeira 2015 Nuevos Retos en la Cardiología Intervencionista.Posición...

SHCI - Sección de Hemodinámica y Cardiología Intervencionista

Meld scoring

Dr. Rohit Saini

The document discusses the development and evolution of the MELD scoring system for prioritizing organ allocation for liver transplantation. Some key points: - MELD was developed in 2000 to predict short-term prognosis for patients with chronic liver disease as an improvement over the CTP classification system. It is based on three readily available lab values: bilirubin, INR, and creatinine. - In 2002, MELD was adopted by UNOS as the primary tool for allocating livers in the US, prioritizing the "sickest first." This led to a 12% reduction in waiting list mortality. - Subsequent refinements included MELD-Na incorporating sodium levels and iMELD

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kidney stones are common after bariatric surgery

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National Comparative Audit of Lower GI Bleeding

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Using primary care databases to evaluate drug benefits and harms: are the res...

Laparoscopic Liver Resection : What to do and not do - Pr Daniel CHERQUI

Olivecrona GK et al.

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PCI & AimRadial 2018 | Innovation in Cardiovascular Medicine - Tim A. Fischell

International Chair on Interventional Cardiology and Transradial Approach

This document summarizes Tim Fischell's presentation on innovation in cardiovascular medicine. It discusses Fischell's history of medical device innovations, including the Arrow-Fischell sheath, brachytherapy devices, stents, and the AngelMed Guardian system. It provides guidance on developing new ideas into real innovations, including evaluating intellectual property, regulatory pathways, prototype testing, and clinical trials. Fischell emphasizes the importance of understanding unmet clinical needs and having a team approach to translating ideas into impactful new technologies.

PCI & AimRadial 2018 | A novel stent concept for South America - Ramses Galaz

International Chair on Interventional Cardiology and Transradial Approach

This document discusses opportunities for developing and manufacturing medical devices in Latin America, including coronary stents with an estimated $500M annual market. It outlines the roadmap needed to design, test, manufacture, and gain regulatory approval for a novel stent concept, including requirements for structure and flow, deployability and patency, and clinical performance. Design considerations are discussed such as structural rigidity, flexural rigidity, surface finish, and hemodynamic simulations. The potential for low-cost manufacturing and animal studies are also mentioned.

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International Chair on Interventional Cardiology and Transradial Approach

PCI & AimRadial 2018 | Radial vs Femoral: Review of the Evidence in 2018 - Ia...

International Chair on Interventional Cardiology and Transradial Approach

This document summarizes the evidence from multiple randomized clinical trials that support a Class IA recommendation for the use of radial artery access (TRA) over femoral artery access (TFA) for cardiac catheterization procedures. The data show that TRA is associated with lower rates of major vascular complications and major bleeding compared to TFA, with numbers needed to treat of 21 and 47 respectively. TRA may also reduce mortality in patients with acute coronary syndrome, with a number needed to treat of 100. Both the 2018 AHA guidelines and ESC/EACTS guidelines were updated to strongly recommend a radial-first approach in light of the overwhelming data demonstrating benefits of TRA over TFA.

PCI & AimRadial 2018 | Best practices in same day discharge - Ivo Bernat

International Chair on Interventional Cardiology and Transradial Approach

This document discusses best practices for same day discharge after cardiac procedures. It provides an overview of the history and evidence supporting same day discharge. Key points include: - Same day discharge has been shown to be safe and effective in studies dating back to the 1990s. - Dedicated lounges and infrastructure improve outcomes for same day discharge by allowing for close monitoring and care in the immediate post-procedure period. - The author's hospital has successfully performed over 7,000 same day discharge procedures over 10 years using a dedicated radial lounge with trained nursing staff who provide care and arrange discharge. Complication rates are low with their protocol.

PCI & AimRadial 2018 | Even the big boss fail - Zoltán Ruzsa

International Chair on Interventional Cardiology and Transradial Approach

This document describes a case of critical hand ischemia treated through multiple endovascular interventions over several years. Initially, the patient underwent brachial artery recanalization and stenting from left radial access, but presented two days later with stent thrombosis. A second procedure recanalized the stent and treated a brachial dissection with another stent. However, two years later the patient returned with re-occlusion of arm vessels and iliac arteries. Further interventions were needed to recanalize stenosed iliac and brachial arteries over time. In conclusion, long term patency of arm interventions is unknown, and stent CTO recanalization in the arms poses similar challenges to the legs.

PCI & AimRadial 2018 | Contemporary Transradial Access Practices: Results of ...

International Chair on Interventional Cardiology and Transradial Approach

PCI & AimRadial 2018 | A Growing Population in the Cath Lab: Patient Identifi...

International Chair on Interventional Cardiology and Transradial Approach

This document discusses expanding the FDA indication for protected PCI procedures using the Impella heart pump. Key points include: 1. A study of 891 patients found that those with mildly/moderately reduced ejection fraction (LVEF >35%) undergoing protected PCI had favorable outcomes similar to those with severely reduced LVEF, despite being older with more comorbidities and complex coronary disease. 2. Protected PCI with Impella led to improved LVEF and quality of life in multiple studies. The Protect II trial showed Impella reduced MACCE by 29% compared to IABP at 30 days. 3. Guidelines recommend protected PCI for patients with severe/moderate/mild reduced LVE

PCI & AimRadial 2018 | Treating Cardiogenic Shock with Impella with Escalatio...

International Chair on Interventional Cardiology and Transradial Approach

PCI & AimRadial 2018 | LEFT MAIN PCILessons from the BCIS registry - Jim Nolan

International Chair on Interventional Cardiology and Transradial Approach

This document summarizes the findings of a study analyzing 19,482 left main stem percutaneous coronary intervention (LMS-PCI) procedures from the British Cardiovascular Intervention Society National Database between 2007-2014: 1) Use of radial artery access for LMS-PCI increased significantly over time and radial access was associated with reduced vascular complications, major bleeding, and shorter hospital stays. 2) Radial access was independently associated with lower in-hospital mortality and major adverse cardiac and cerebrovascular events (MACE) compared to femoral access. 3) Independent predictors of 12-month mortality following LMS-PCI included acute kidney injury, older age, chronic renal failure, acute coronary syndrome presentation, and

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International Chair on Interventional Cardiology and Transradial Approach

PCI & AimRadial 2018 | Right Heart Access by Radial - Ian C Gilchrist

International Chair on Interventional Cardiology and Transradial Approach

This document discusses accessing the right heart and central venous system through the radial vein as a safer alternative to traditional femoral access. It provides tips for establishing venous access through the forearm, including using ultrasound or no-touch technology to locate veins and heparin locks to improve efficiency. Challenges like low venous pressure, valves, and junctions are addressed. Images demonstrate techniques for navigating the radial artery into the right atrium, including using flushes of saline. Potential contraindications like arm trauma or breast cancer are noted. The document argues learning both arterial and venous radial techniques will improve cardiologist skills and safety.

PCI & AimRadial 2018 | Radial Artery Puncture - Ian C Gilchrist

International Chair on Interventional Cardiology and Transradial Approach

This document discusses techniques for radial artery puncture for cardiovascular procedures. It notes that the radial artery is smaller in diameter than the femoral artery. Successful radial access requires correctly positioning and securing the wrist. Ultrasound guidance can help find and access the radial artery, especially for trainees. The initial puncture approach can be anterior wall only or use a counterpuncture technique. Sheath size, length, and coating impact radial artery spasm and occlusion. Cocktails including nitroglycerine and calcium channel blockers are commonly used but acid in the cocktail may damage the artery if felt by the patient.

PCI & AimRadial 2018 | Post-PCI FFR: Time is coming - Olivier F. Bertrand

International Chair on Interventional Cardiology and Transradial Approach

This document summarizes a presentation given by Dr. Olivier Bertrand on post-PCI FFR measurement. It discusses studies showing that a post-PCI FFR of 0.90 or higher is associated with lower rates of re-PCI and major adverse cardiac events. It then outlines the proposed PREDICT randomized study to evaluate whether routine post-PCI FFR measurement can guide PCI strategy and completion. The study would measure FFR after successful PCI in all-comers and randomize patients to clinical follow-up alone or with guidance from the post-PCI FFR results. The goal is to establish if physiology-guided PCI optimization can improve outcomes and reduce costs.

PCI & AimRadial 2018 | Lessons from iFR-SWEDEHEART and DEFINE-FLAIR - Hitoshi...

International Chair on Interventional Cardiology and Transradial Approach

This document summarizes lessons learned from the DEFINE-FLAIR and iFR-SWEDEHEART clinical trials. The trials found: 1) Decision-making based on instantaneous wave-free ratio (iFR) was non-inferior to fractional flow reserve (FFR) for guiding revascularization and reducing major adverse cardiac events over 1-2 years. 2) iFR-guided decisions resulted in significantly less revascularization procedures compared to FFR. 3) Subgroup analysis found increased event rates among diabetic patients evaluated with FFR compared to iFR. 4) iFR has been upgraded to a Class IA recommendation in European Society of Cardiology guidelines based on these trials

PCI & AimRadial 2018 | Use of physiology in ACS - Colin Berry

International Chair on Interventional Cardiology and Transradial Approach

1. The document discusses the use of physiology in acute coronary syndrome (ACS) patients, including trials evaluating fractional flow reserve (FFR) and index myocardial resistance (IMR) measurements. 2. Several trials showed that FFR-guided revascularization in multivessel disease STEMI patients reduced major cardiac events compared to culprit-only PCI or medical therapy. Ongoing trials are further evaluating FFR in ACS. 3. IMR predicts mortality and heart failure in STEMI patients and adversely remodeling post-STEMI. 4. Incomplete revascularization is common in ACS and associated with worse outcomes; FFR may help guide more complete revascularization. The clinical utility of physiology in ACS

PCI & AimRadial 2018 | FFR using 4Fr catheters: Can Slender Technique Work He...

International Chair on Interventional Cardiology and Transradial Approach

This document discusses the potential use of 4 French (4F) catheters for fractional flow reserve (FFR) measurements as a less invasive alternative to larger catheters. It notes that 4F catheters have a smaller profile but can lack the ability to directly perform percutaneous coronary intervention if needed. The document outlines key considerations for using 4F catheters, including ensuring the catheter lumen is well flushed and the pressure transducer is not damped. It concludes that improvements are still needed, such as reducing friction between the pressure wire and catheter, in order to maximize the benefits of using the smallest catheter size possible.

PCI & AimRadial 2018 | FFR in Left Main Disease - William F. Fearon

International Chair on Interventional Cardiology and Transradial Approach

This document discusses using fractional flow reserve (FFR) to evaluate ambiguous left main coronary artery disease. It presents a case of an 82-year-old woman with chest pain and a recent stent in the circumflex artery. FFR measurements of the left main and left anterior descending artery were 0.64, indicating significance. Intravascular ultrasound also suggested significance. The left main and proximal left anterior descending artery were stented, and post-procedure FFR measurements improved. The document reviews evidence that FFR can safely guide decisions about revascularization of ambiguous left main lesions.

PCI & AimRadial 2018 | FFR-CT - Colin Berry

International Chair on Interventional Cardiology and Transradial Approach

This document summarizes a presentation on CT-derived fractional flow reserve (FFR-CT). It discusses how FFR-CT increases the positive predictive value of coronary CT angiography (CTCA). Several landmark studies are summarized that evaluated the diagnostic accuracy of FFR-CT compared to CTCA. The PACIFIC trial findings showing high diagnostic accuracy of FFR-CT are described. Ongoing and upcoming clinical trials using FFR-CT like PRECISION and DECISION are mentioned. Novel applications of FFR-CT for biomechanics analysis and PCI planning are presented. Finally, new methods like user-generated CT-FFR that may reduce processing time are introduced, though accuracy needs further evaluation.

PCI & AimRadial 2018 | Image based FFR during coronary angiography - Hitoshi...

International Chair on Interventional Cardiology and Transradial Approach

This document summarizes the results of a study evaluating the diagnostic accuracy of quantitative flow ratio (QFR) compared to fractional flow reserve (FFR) as the reference standard. The study included 317 lesions in 273 patients. Key results included: - QFR showed superior sensitivity and specificity for detecting functionally significant lesions compared to 2D quantitative coronary angiography. - QFR values correlated well with invasive FFR measurements. - QFR could be computed within a similar time frame as FFR measurements. - A hybrid approach using QFR and FFR may allow pressure wire-free assessment in 68% of lesions while maintaining high diagnostic accuracy.

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