Fractional Flow Reserve or Optical Coherence Tomography to Guide Management of Angiographically Intermediate Coronary Stenosis

Optical coherence tomography-based machine learning for predicting fractional flow reserve in intermediate coronary stenosis: a feasibility study

“…Although there are no randomized clinical data, OCT-guided interventions have been introduced as promising tools for patients with stable coronary artery disease as well as for those with acute coronary syndrome 16 . A recent study reported that OCT-based PCI had a lower rate of both major adverse cardiac events and significant angina than those of FFR-based PCI, suggesting the importance of the assessments of the coronary vessel anatomy 17 . However, the cost-effectiveness of FFR and its power to determine the status of ischemia are still important in daily practice.…”

Advances in Clinical Cardiology 2019: A Summary of Key Clinical Trials

“…The primary endpoint of 9-month target vessel fractional flow reserve (FFR) was similar in DCB and DES groups (0.92 ± 0.05 vs. 0.91 ± 0.06) although given the relatively small numbers in the study, further confirmatory data are desirable. It is often said that intracoronary physiology helps guide whether or not PCI should be done, and intracoronary imaging helps guide how best to optimise the PCI, if it needs to be [11]. The primary endpoint (MACE or significant angina) was significantly higher with FFR vs. OCT guidance (14.8% vs. 8.0%; P = 0.048).…”

“…It is often said that intracoronary physiology helps guide whether or not PCI should be done, and intracoronary imaging helps guide how best to optimise the PCI, if it needs to be done. Interesting, the FFR or OCT Guidance to RevasculariZe Intermediate Coronary Stenosis Using Angioplasty (FORZA) single-centre trial randomised 350 patients with 446 separate angiographically intermediate coronary lesions to either an FFR-guided strategy (PCI if FFR < 0.80) or an optical coherence tomography (OCT)-guided strategy (PCI if area stenosis ≥ 75%, if area stenosis 50–75% with minimal lumen area < 2.5 mm 2 , or if visible plaque rupture) [ 11 ]. The primary endpoint (MACE or significant angina) was significantly higher with FFR vs. OCT guidance (14.8% vs. 8.0%; P = 0.048).…”

A case of mild‐to‐intermediate left‐main lesion with high‐risk plaque features: “Blindness of physiology” for PCI guidance?

“…Prati et al 13 have demonstrated that patients undergoing PCI with OCT guidelines required in 35% further intervention that translated into significantly lower rate of cardiac death and myocardial infarction. In the only randomized study comparing OCT with FFR‐guided PCI 14 that includes 350 patients with 446 intermediate lesions, OCT guidance (including stenosis severity and plaque rupture as indication for PCI) was associated with lower rate of composite major adverse cardiac events or angina over 13 months (14.8% vs 8%). Recently, CLIMA study 15 in more than 1000 patients identified certain OCT high‐risk features—intimal cap thickness of less than 75 µm findings, stenosis severity, long lipid arch, and OCT‐defined macrophages—as predictors of future adverse hard clinical events, death and target lesion related myocardial infarction.…”