Circulation. Cardiovascular interventions · 2026
Angiography-Derived FFR Versus IVUS to Guide PCI According to Angiographic Lesion Characteristics.
СтатьяСравнительное исследованиеРандомизированное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Yang Seokhun, Hu Xinyang, Zhang Jinlong, Song Jin-Eun, Jiang Jun, Peng Xiaoping, Lu Dongsheng, Pan Yibin, Guo Lijun, Li Jilin, He Wenming, Zhou Hao, Pu Jun, Huang Jinyu, Jiang Fan, Liu Qiang, Song Daqing, Lu Liang, Cheng Zhenfeng, Yang Bin, Ma Jianliang, Chen Peng, Li Shiqiang, Meng Zhaohui, Tang Lijiang, Fan Yongzhen, Shin Eun-Seok, Tu Shenxian, Nam Chang-Wook, Fearon William F, Wang Jian'an, Koo Bon-Kwon, FLAVOUR II Study Group
Аннотация
BACKGROUND: While angiography-derived fractional flow reserve (AngioFFR)- and intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) yield similar outcomes, with AngioFFR associated with lower PCI rates, the relative clinical effectiveness of AngioFFR versus IVUS-guided PCI according to angiographic lesion characteristics remains unclear.
METHODS: This post hoc analysis of the FLAVOUR II trial (Comparison of Angiography-Derived Fractional Flow Reserve- and Intravascular Ultrasound-Guided Intervention Strategy for Clinical Outcomes in Patients with Coronary Artery Disease) included patients with ≥50% stenosis randomized to AngioFFR- or IVUS-guided PCI. A composite lesion risk score was derived using a marginal Cox model-based linear predictor incorporating % diameter stenosis, lesion length, true bifurcation, ostial lesion, and heavy calcification. The primary end point was target vessel failure (TVF: cardiac death, target vessel myocardial infarction, and target vessel revascularization).
RESULTS: Among 1726 patients, 884 (51.2%) underwent AngioFFR-guided PCI and 842 (48.8%) underwent IVUS-guided PCI. During a median 12-month follow-up, TVF occurred in 2.4% of AngioFFR-treated vessels and 1.9% of IVUS-treated vessels (P=0.50). TVF risk increased progressively with a higher composite lesion risk score (adjusted hazard ratio, 2.76 [95% CI, 1.35-5.65]). This association was more pronounced in the AngioFFR group (adjusted hazard ratio, 3.93 [95% CI, 1.79-8.63]) than in the IVUS group (adjusted hazard ratio, 1.62 [95% CI, 0.42-6.22]). Compared with IVUS guidance, AngioFFR-guided vessels with high-risk lesions (score >0.32) had a higher TVF rate (5.1% versus 1.9%; P=0.010), whereas outcomes were comparable in those with low-risk lesions (1.5% versus 1.9%; P=0.531). AngioFFR guidance was associated with lower target vessel PCI rates in low-risk lesions (60.1% versus 76.5%; P<0.001), whereas PCI rates were uniformly high and similar between groups in high-risk lesions (96.4% versus 97.4%; P=0.675).
CONCLUSIONS: A higher composite lesion risk score was associated with increased PCI rates and TVF risk after AngioFFR- or IVUS-guided treatment. AngioFFR guidance was associated with lower PCI rates in low-risk lesions, whereas IVUS guidance may yield more favorable outcomes in high-risk lesions.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04397211.
METHODS: This post hoc analysis of the FLAVOUR II trial (Comparison of Angiography-Derived Fractional Flow Reserve- and Intravascular Ultrasound-Guided Intervention Strategy for Clinical Outcomes in Patients with Coronary Artery Disease) included patients with ≥50% stenosis randomized to AngioFFR- or IVUS-guided PCI. A composite lesion risk score was derived using a marginal Cox model-based linear predictor incorporating % diameter stenosis, lesion length, true bifurcation, ostial lesion, and heavy calcification. The primary end point was target vessel failure (TVF: cardiac death, target vessel myocardial infarction, and target vessel revascularization).
RESULTS: Among 1726 patients, 884 (51.2%) underwent AngioFFR-guided PCI and 842 (48.8%) underwent IVUS-guided PCI. During a median 12-month follow-up, TVF occurred in 2.4% of AngioFFR-treated vessels and 1.9% of IVUS-treated vessels (P=0.50). TVF risk increased progressively with a higher composite lesion risk score (adjusted hazard ratio, 2.76 [95% CI, 1.35-5.65]). This association was more pronounced in the AngioFFR group (adjusted hazard ratio, 3.93 [95% CI, 1.79-8.63]) than in the IVUS group (adjusted hazard ratio, 1.62 [95% CI, 0.42-6.22]). Compared with IVUS guidance, AngioFFR-guided vessels with high-risk lesions (score >0.32) had a higher TVF rate (5.1% versus 1.9%; P=0.010), whereas outcomes were comparable in those with low-risk lesions (1.5% versus 1.9%; P=0.531). AngioFFR guidance was associated with lower target vessel PCI rates in low-risk lesions (60.1% versus 76.5%; P<0.001), whereas PCI rates were uniformly high and similar between groups in high-risk lesions (96.4% versus 97.4%; P=0.675).
CONCLUSIONS: A higher composite lesion risk score was associated with increased PCI rates and TVF risk after AngioFFR- or IVUS-guided treatment. AngioFFR guidance was associated with lower PCI rates in low-risk lesions, whereas IVUS guidance may yield more favorable outcomes in high-risk lesions.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04397211.
Предметные рубрики MeSH
HumansUltrasonography, InterventionalCoronary AngiographyPercutaneous Coronary InterventionCoronary Artery DiseasePredictive Value of TestsTreatment OutcomeFractional Flow Reserve, MyocardialRisk FactorsFemaleMaleCoronary StenosisTime FactorsAgedMiddle AgedSeverity of Illness IndexRisk AssessmentCoronary Vessels