계명대학교 의학도서관 Repository

Physiology- or Imaging-Guided Strategies for Intermediate Coronary Stenosis

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Author(s)
Seokhun YangJeehoon KangDoyeon HwangJinlong ZhangJun JiangXinyang HuJoo-Yong HahnChang-Wook NamJoon-Hyung DohBong-Ki LeeWeon KimJinyu HuangFan JiangHao ZhouPeng ChenLijiang TangWenbing JiangXiaomin ChenWenming HeSung Gyun AhnMyeong-Ho YoonUng KimJoo Myung LeeYou-Jeong KiEun-Seok ShinHyo-Soo KimSeung-Jea TahkJian'an WangBon-Kwon Koo
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Dept. of Radiology (영상의학)
Journal Title
JAMA Netw Open
Issued Date
2024
Volume
7
Issue
1
Abstract
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.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
2574-3805
Source
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2813462
DOI
10.1001/jamanetworkopen.2023.50036
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45531
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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