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- Title
Physiology- or Imaging-Guided Strategies for Intermediate Coronary Stenosis.
- Authors
Yang, Seokhun; Kang, Jeehoon; Hwang, Doyeon; Zhang, Jinlong; Jiang, Jun; Hu, Xinyang; Hahn, Joo-Yong; Nam, Chang-Wook; Doh, Joon-Hyung; Lee, Bong-Ki; Kim, Weon; Huang, Jinyu; Jiang, Fan; Zhou, Hao; Chen, Peng; Tang, Lijiang; Jiang, Wenbing; Chen, Xiaomin; He, Wenming; Ahn, Sung Gyun
- Abstract
Key Points: Question: Are fractional flow reserve (FFR) and intravascular ultrasonography (IVUS) parameters associated with target vessel failure (TVF) according to treatment type after FFR- or IVUS-guided treatment? Findings: In this cohort study of 1619 patients and 1753 vessels with intermediate coronary stenosis from a randomized clinical trial, clinical outcomes were similar between FFR- and IVUS-guided treatment groups within deferred and revascularized vessels. Vessels with FFR greater than 0.92 in the FFR group or minimum lumen area greater than 4.5 mm2 or plaque burden 58% or less in the IVUS group were low–TVF risk deferred vessels, and post–percutaneous coronary intervention vessels with FFR 0.80 or less in the FFR group or minimum stent area 6.0 mm2 or less and plaque burden at stent edge greater than 58% in the IVUS group were high–TVF risk revascularized vessels. Meaning: These findings suggest that binary FFR and IVUS parameters could enhance risk stratification for future clinical events, such as TVF, in deferred and revascularized vessels. This cohort study assesses risk of target vessel failure after treatment according to treatment type and fractional flow reserve and intravascular ultrasonography parameters among patients with intermediate coronary stenosis. Importance: Treatment strategies for intermediate coronary lesions guided by fractional flow reserve (FFR) and intravascular ultrasonography (IVUS) have shown comparable outcomes. Identifying low-risk deferred vessels to ensure the safe deferral of percutaneous coronary intervention (PCI) and high-risk revascularized vessels that necessitate thorough follow-up can help determine optimal treatment strategies. Objectives: To investigate outcomes according to treatment types and FFR and IVUS parameters after FFR- or IVUS-guided treatment. Design, Setting, and Participants: This cohort study included patients with intermediate coronary stenosis from the Fractional Flow Reserve and Intravascular Ultrasound-Guided Intervention Strategy for Clinical Outcomes in Patients With Intermediate Stenosis (FLAVOUR) trial, an investigator-initiated, prospective, open-label, multicenter randomized clinical trial that assigned patients into an IVUS-guided strategy (which recommended PCI for minimum lumen area [MLA] ≤3 mm2 or 3 mm2 to 4 mm2 with plaque burden [PB] ≥70%) or an FFR-guided strategy (which recommended PCI for FFR ≤0.80). Data were analyzed from November to December 2022. Exposures: FFR or IVUS parameters within the deferred and revascularized vessels. Main Outcomes and Measures: The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, and revascularization at 2 years. Results: A total of 1619 patients (mean [SD] age, 65.1 [9.6] years; 1137 [70.2%] male) with 1753 vessels were included in analysis. In 950 vessels for which revascularization was deferred, incidence of TVF was comparable between IVUS and FFR groups (3.8% vs 4.1%; P =.72). Vessels with FFR greater than 0.92 in the FFR group and MLA greater than 4.5 mm2 or PB of 58% or less in the IVUS group were identified as low-risk deferred vessels, with a decreased risk of TVF (hazard ratio [HR], 0.25 [95% CI, 0.09-0.71]; P =.009). In 803 revascularized vessels, the incidence of TVF was comparable between IVUS and FFR groups (3.6% vs 3.7%; P =.95), which was similar in the revascularized vessels undergoing PCI optimization (4.2% vs 2.5%; P =.31). Vessels with post-PCI FFR of 0.80 or less in the FFR group or minimum stent area of 6.0 mm2 or less or with PB at stent edge greater than 58% in the IVUS group had an increased risk for TVF (HR, 7.20 [95% CI, 3.20-16.21]; P <.001). Conclusions and Relevance: In this cohort study of patients with intermediate coronary stenosis, FFR- and IVUS-guided strategies showed comparable outcomes in both deferred and revascularized vessels. Binary FFR and IVUS parameters could further define low-risk deferred vessels and high-risk revascularized vessels.
- Subjects
BIOMARKERS; STATISTICS; CORONARY artery stenosis; ULTRASONIC imaging; PERCUTANEOUS coronary intervention; CONFIDENCE intervals; TREATMENT effectiveness; CORONARY circulation; CORONARY angiography; RISK assessment; MYOCARDIAL revascularization; DESCRIPTIVE statistics; RESEARCH funding; DATA analysis; LONGITUDINAL method
- Publication
JAMA Network Open, 2024, Vol 7, Issue 1, pe2350036
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.50036