Prospective Randomized Comparison of Fractional Flow Reserve Versus Optical Coherence Tomography to Guide Revascularization of Intermediate Coronary Stenoses: One‐Month Results

Leone, Antonio Maria; Burzotta, Francesco; Aurigemma, Cristina; Maria, Giovanni Luigi De; Zambrano, Aniello; Zimbardo, Giuseppe; Arioti, Manfredi; Cerracchio, Emma; Vergallo, Rocco; Trani, Carlo; Crea, Filippo

doi:10.1161/jaha.119.012772

Cited by 13 publications

(22 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Probably this advantage is due to the morphological guidance by the OCT in addition to physiological significance. 22 The results of our study give the information that FFR measured with the intracoronary pressure wire alone, may not be a sufficient tool for guiding revascularization in patients admitted with moderate coronary lesions. Probably addition of clinical data like risk factors, especially diabetes mellitus, clinical presentation, left ventricular function, prior PCI/ CABG status, and associated comorbidities along with FFR values are better predictors for the MACE.…”

Section: Discussionmentioning

confidence: 80%

Outcomes of Deferred Revascularization Following Physiological Coronary Assessment Using Fractional Flow Reserve

et al. 2019

View full text Add to dashboard Cite

Objective Outcomes of patients with deferred revascularization for intermediate stenosis coronary lesion based upon physiological assessment using fractional flow reserve ([FFR] >0.80). Methods Patients with chest pain with angiographic intermediate stenosis, (40–70% stenosis) without noninvasive test evidence of ischemia were selected and underwent an FFR assessment between January 1, 2015, and August 31, 2018. Patients with intermediate lesions of FFR > 0.80 were followed, and those patients with lesion with FFR < 0.8 were excluded from the study. The primary outcomes of the study were to know the composite of target lesion revascularization (TLR), myocardial infarction (MI), and other vascular complications (major adverse cardiovascular events [MACE]). Results In 102 patients who underwent deferred revascularization (FFR > 0.80), 104 FFR studies were done and followed over one year. Four patients needed target lesion revascularization (3.92%). Three patients underwent percutaneous coronary intervention (2.94%) within nine months of follow-up, and one patient underwent coronary artery bypass graft (CABG) (0.98%) at one year of follow-up. Two patients died with acute MI with sudden cardiac arrest (1.96%). Two patients developed right hemiparesis (2.94%) on one year of follow-up due to acute ischemic stroke of a middle cerebral artery, and one patient underwent permanent pacemaker implantation for complete heart block (CHB). The incidence of the total events was 8.82%, TLR was 3.92%, Coronary event rate was 5.88%, and MACE was 7.84%. Conclusions Our study shows that there was a significant increase in the incidence of coronary event rate (5.88%) and the MACE rate (7.84%) in patients of deferred coronary revascularization based on higher FFR values (>0.8).

show abstract

Section: Discussionmentioning

confidence: 80%

Outcomes of Deferred Revascularization Following Physiological Coronary Assessment Using Fractional Flow Reserve

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Thus, we performed a novel analysis of the FORZA trial after an extended follow-up time of 24 months, comparing the subgroup of patients in which PCI was originally deferred based on FFR or OCT. So far, we observed that FFR was associated with lower costs and higher medical management rate while OCT reduced the composite endpoint of major adverse cardiac events (MACE) or significant angina at 13-month [9,10].…”

Section: Discussionmentioning

confidence: 99%

PCI Deferral Based on Fractional Flow Reserve or Optical Coherence Tomography: Two-Year Results of the Forza Trial

Leone¹,

Burzotta²,

Aurigemma³

et al. 2022

Rev. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

Backgroud:The "FFR or OCT Guidance to Revascularize Intermediate Coronary Stenosis Using Angioplasty" (FORZA) trial showed that in patients with angiographically intermediate coronary lesions (AICLs), optical coherence tomography (OCT) guidance of percutaneous coronary intervention (PCI) reduced the occurrence of the composite endpoint of major adverse cardiac events (MACE) or significant angina at 13 months, while fractional flow reserve (FFR) guidance was associated with a higher rate of medical management and with lower costs. Safety of PCI deferral when FFR >0.80 is known, while data on clinical outcomes using an OCT guidance are lacking. We assessed the safety of PCI deferral based on OCT findings. Methods: This is a subgroups analysis of the FORZA Trial focusing on the clinical outcome of patients in whom PCI was originally deferred. In details, patients with AICLs were randomized to FFR or OCT imaging. In the FFR arm, PCI was deferred if FFR was >0.80 while in the OCT arm in the absence of any of the following conditions: area stenosis >75%, or 50% to 75% with minimum lumen area <2.5 mm 2 or plaque rupture. Angina status (evaluated using the Seattle Angina Questionnaire, SAQ), MACE (death, myocardial infarction, target vessel revascularization) and rate of patients treated with optimal medical therapy alone were assessed at 24 months. Results: From a total of 350 patients with 446 AICLs enrolled in the trial (176 randomized to FFR and 174 to OCT), based on the predefined FFR and OCT criteria, PCI was deferred in 119 patients (67.6%) in the FFR arm, and in 82 patients (47.1%) in the OCT arm. At 24-months follow-up, significant residual angina (defined as a value <90 on the angina frequency scale) was observed in 6 patients (5.0%) in the FFR arm, and in 6 patients (7.3%) in the OCT arm (p = 0.55). Rate of MACE was 10.9% in the FFR arm and 6.1% in the OCT arm (p = 0.32). The number of patients managed by optimal medical therapy alone was still significantly higher using FFR than OCT guidance also at 24 months (60.2% vs 44.2%, p = 0.0038). Conclusions: PCI-deferral based on OCT (using the FORZA trial criteria) is safe and associated with numerically less events at 24-months follow up. FFR guidance is still associated with a higher number of patients managed by optimal medical therapy alone.

show abstract

“…This is a post‐hoc analysis based on the Fractional Flow Reserve versus Optical Coherence Tomography to Guide RevasculariZAtion of Intermediate Coronary Stenoses (FORZA) study population (NCT01824030) 10 . The FORZA study is an open‐label, prospective, single‐center, randomized trial designed to compare the costs and rate of adverse clinical outcomes in patients randomized to receive FFR versus OCT‐guided PCI on angiographically intermediate coronary lesion (AICL) 10‐12 . A total of 350 patients with stable or stabilized ischemic heart disease and evidence of AICL were enrolled and randomized 1:1 to FFR guidance or OCT guidance.…”

Section: Methodsmentioning

confidence: 99%

Quantitative flow ratio modulated by intracoronary optical coherence tomography for predicting physiological efficacy of percutaneous coronary intervention

Ding

et al. 2023

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

Background The combination of coronary imaging assessment and blood flow perturbation estimation has the potential to improve percutaneous coronary intervention (PCI) guidance. Objectives We aimed to evaluate a novel method for fast computation of Murray law‐based quantitative flow ratio (μQFR) from coregistered optical coherence tomography (OCT) and angiography (OCT‐modulated μQFR, OCT‐μQFR) in predicting physiological efficacy of PCI. Methods Patients treated by OCT‐guided PCI in the OCT‐arm of the Fractional Flow Reserve versus Optical Coherence Tomography to Guide RevasculariZAtion of Intermediate Coronary Stenoses trial (FORZA, NCT01824030) were included. Based on angiography and OCT before PCI, simulated residual OCT‐μQFR was computed by assuming full stent expansion to the intended‐to‐treat segment. Plaque composition was automatically characterized using a validated artificial intelligence algorithm. Actual post‐PCI OCT‐μQFR pullback was computed based on coregistration of angiography and OCT acquired immediately after PCI. Suboptimal functional stenting result was defined as OCT‐μQFR ≤ 0.90. Results Paired simulated residual OCT‐μQFR and actual post‐PCI OCT‐μQFR were obtained in 76 vessels from 74 patients. Simulated residual OCT‐μQFR showed good correlation (r = 0.80, p < 0.001), agreement (mean difference = −0.02 ± 0.02, p < 0.001), and diagnostic concordance (79%, 95% confidence interval: 70%–88%) with actual post‐PCI OCT‐μQFR. Actual post‐PCI in‐stent OCT‐μQFR had a median value of 0.02 and was associated with left anterior descending artery lesion location (β = 0.38, p < 0.001), higher baseline total plaque burden (β = 0.25, p = 0.031), and fibrous plaque volume (β = 0.24, p = 0.026). Conclusions This study based on patients enrolled in a prospective OCT‐guidance PCI trial shows that simulated residual OCT‐μQFR had good correlation, agreement, and diagnostic concordance with actual post‐PCI OCT‐μQFR. In OCT‐guided procedures, OCT‐μQFR in‐stent pressure drop was low and was significantly predicted by pre‐PCI vessel/plaque characteristics.

show abstract

Prospective Randomized Comparison of Fractional Flow Reserve Versus Optical Coherence Tomography to Guide Revascularization of Intermediate Coronary Stenoses: One‐Month Results

Cited by 13 publications

References 29 publications

Outcomes of Deferred Revascularization Following Physiological Coronary Assessment Using Fractional Flow Reserve

Outcomes of Deferred Revascularization Following Physiological Coronary Assessment Using Fractional Flow Reserve

PCI Deferral Based on Fractional Flow Reserve or Optical Coherence Tomography: Two-Year Results of the Forza Trial

Quantitative flow ratio modulated by intracoronary optical coherence tomography for predicting physiological efficacy of percutaneous coronary intervention

Contact Info

Product

Resources

About