Outcomes of Percutaneous Coronary Intervention in Intermediate Coronary Artery Disease Fractional Flow Reserve–Guided Versus Intravascular Ultrasound–Guided

Abstract

Objectives:

This study sought to evaluate the long-term clinical outcomes of a fractional flow reserve (FFR)–guided percutaneous coronary intervention (PCI) strategy compared with intravascular ultrasound (IVUS)–guided PCI for intermediate coronary lesions.

Background:

Both FFR- and IVUS-guided PCI strategies have been reported to be safe and effective in intermediate coronary lesions.

Methods:

The study included 167 consecutive patients, with intermediate coronary lesions evaluated by FFR or IVUS (FFR-guided, 83 lesions vs. IVUS-guided, 94 lesions). Cutoff value of FFR in FFR-guided PCI was 0.80, whereas that for minimal lumen cross sectional area in IVUS-guided PCI was 4.0 mm2. The primary outcome was defined as a composite of major adverse cardiac events including death, myocardial infarction, and ischemia-driven target vessel revascularization at 1 year after the index procedure.

Results:

Baseline percent diameter stenosis and lesion length were similar in both groups (51 ± 8% and 24 ± 12 mm in the FFR group vs. 52 ± 8% and 24 ± 13 mm in the IVUS group, respectively). However, the IVUS-guided group underwent revascularization therapy significantly more often (91.5% vs. 33.7%, p < 0.001). No significant difference was found in major adverse cardiac event rates between the 2 groups (3.6% in FFR-guided PCI vs. 3.2% in IVUS-guided PCI). Independent predictors for performing intervention were guiding device: FFR versus IVUS (relative risk [RR]: 0.02); left anterior descending coronary artery versus non-left anterior descending coronary artery disease (RR: 5.60); and multi- versus single-vessel disease (RR: 3.28).

Conclusions:

Both FFR- and IVUS-guided PCI strategy for intermediate coronary artery disease were associated with favorable outcomes. The FFR-guided PCI reduces the need for revascularization of many of these lesions.