Clinical Outcomes of Deferred Lesions by IVUS Versus FFR-Guided Treatment Decision-Reference-Cited by-同舟云学术

Clinical Outcomes of Deferred Lesions by IVUS Versus FFR-Guided Treatment Decision

Published:2023-12 Issue:12 Volume:16 Page:
ISSN:1941-7640
Container-title:Circulation: Cardiovascular Interventions
language:en
Short-container-title:Circ: Cardiovascular Interventions

Author:

Lee Joo Myung¹,Kim Hangyul¹^ORCID,Hong David¹^ORCID,Hwang Doyeon²,Zhang Jinlong³^ORCID,Hu Xinyang³^ORCID,Jiang Jun³^ORCID,Nam Chang-Wook⁴^ORCID,Doh Joon-Hyung⁵^ORCID,Lee Bong-Ki⁶^ORCID,Kim Weon⁷,Huang Jinyu⁸,Jiang Fan⁹,Zhou Hao¹⁰,Chen Peng¹¹,Tang Lijiang¹²,Jiang Wenbing¹³,Chen Xiaomin¹⁴,He Wenming¹⁵^ORCID,Kang Jeehoon²,Ahn Sung-Gyun¹⁶,Yoon Myeong-Ho¹⁷^ORCID,Kim Ung¹⁸^ORCID,Ki You-Jeong¹⁹^ORCID,Shin Eun-Seok²⁰^ORCID,Choi Ki Hong¹^ORCID,Park Taek Kyu¹^ORCID,Yang Jeong Hoon¹^ORCID,Song Young Bin¹^ORCID,Choi Seung-Hyuk¹^ORCID,Gwon Hyeon-Cheol¹^ORCID,Koo Bon-Kwon²,Kim Hyo-Soo²^ORCID,Tahk Seung-Jea¹⁷^ORCID,Wang Jian’an²³,Hahn Joo-Yong¹^ORCID,

Affiliation:

1. Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.).

2. Seoul National University Hospital, Republic of Korea (D. Hwang, J.K., B.-K.K., H.-S.K., J.W.).

3. The Second Affiliated Hospital (J.Z., X.H., J.J., J.W.), Zhejiang University School of Medicine, China.

4. Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (C.-W.N.).

5. Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (J.-H.D.).

6. Kangwon National University Hospital, Chuncheon, Republic of Korea (B.-K.L.).

7. Kyung Hee University Hospital, Seoul, Republic of Korea (W.K.).

8. Affiliated Hangzhou First People’s Hospital (J.H.), Zhejiang University School of Medicine, China.

9. Hangzhou Normal University Affiliated Hospital, China (F.J.).

10. The First Affiliated Hospital of Wenzhou Medical University, China (H.Z.).

11. The Second Affiliated Hospital of Wenzhou Medical University, China (P.C.).

12. Zhejiang Hospital, Hangzhou, China (L.T.).

13. The Third Clinical Institute Affiliated to Wenzhou Medical University, China (W.J.).

14. Ningbo First Hospital, China; (X.C.).

15. The Affiliated Hospital of Medical School of Ningbo University, China (W.H.).

16. Wonju Severance Christian Hospital, Republic of Korea (S.-G.A.).

17. Ajou University Hospital, Suwon, Republic of Korea (M.-H.Y., S.-J.T.).

18. Yeungnam University Medical Center, Daegu, Republic of Korea (U.K.).

19. Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Republic of Korea (Y.-J.K.).

20. Ulsan University Hospital, University of Ulsan College of Medicine, Republic of Korea (E.-S.S.).

Abstract

BACKGROUND: There are limited data regarding the safety of deferral of percutaneous coronary intervention based on intravascular ultrasound (IVUS) findings. The current study sought to compare the prognosis between deferred lesions based on IVUS and fractional flow reserve (FFR)–guided treatment decision. METHODS: This study is a post hoc analysis of the FLAVOUR randomized trial (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients With Intermediate Stenosis) that compared 2-year clinical outcomes between IVUS- and FFR-guided treatment decision on intermediate coronary artery lesions using predefined criteria. In both IVUS and FFR groups, vessels were classified into deferred or revascularized vessels, and patients were classified as those with or without deferred lesions. Vessel-oriented composite outcomes (cardiac death, target vessel myocardial infarction, or target vessel revascularization) in deferred vessels and patient-oriented composite outcomes (death, myocardial infarction, or any revascularization) in patients with deferred lesions were compared between the IVUS and FFR groups. RESULTS: A total of 1682 patients and 1820 vessels were analyzed, of which 922 patients and 989 vessels were deferred. At 2 years, there was no difference in the cumulative incidence of vessel-oriented composite outcomes in deferred vessels between IVUS (n=375) and FFR (n=614) groups (3.8% versus 4.1%; hazard ratio, 0.91 [95% CI, 0.47–1.75]; P =0.77). The risk of vessel-oriented composite outcomes was comparable between deferred and revascularized vessels following treatment decision by IVUS (3.8% versus 3.5%; hazard ratio, 1.09 [95% CI, 0.54–2.19]; P =0.81) and FFR (4.1% versus 3.6%; hazard ratio, 1.14 [95% CI, 0.56–2.32]; P =0.72). In comparison of patient-oriented composite outcomes in patients with deferred lesions, there was no significant difference between the IVUS (n=357) and FFR (n=565) groups (6.2% versus 5.9%; hazard ratio, 1.05 [95% CI, 0.61–1.80]; P =0.86). CONCLUSIONS: In patients with intermediate coronary artery stenosis, deferral of percutaneous coronary intervention based on IVUS-guided treatment decision showed comparable risk of clinical events with FFR-guided treatment decision. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02673424.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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