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Outcomes of percutaneous coronary intervention in intermediate coronary artery disease: fractional flow reserve-guided versus intravascular ultrasound-guided.

Nam, CW; Yoon, HJ; Cho, YK; Park, HS; Kim, H; Hur, SH; Kim, YN; Chung, IS; Koo, BK; Tahk, SJ; Fearon, WF; Kim, KB
JACC. Cardiovascular interventions, 3(8):812-817, 2010
Journal Title
JACC. Cardiovascular interventions
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 mm(2). 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.
MeSH terms
Aged*Angioplasty, Balloon, Coronary/adverse effects/instrumentation/mortalityChi-Square Distribution*Coronary AngiographyCoronary Stenosis/mortality/physiopathology/*therapy/ultrasonographyFemale*Fractional Flow Reserve, MyocardialHumansKaplan-Meier EstimateLogistic ModelsMaleMiddle AgedMyocardial Infarction/etiologyPredictive Value of TestsRetrospective StudiesRisk AssessmentRisk FactorsSeverity of Illness IndexStentsTime FactorsTreatment Outcome*Ultrasonography, Interventional
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