1. Optical coherence tomography compared with fractional flow reserve guided approach in acute coronary syndromes: A propensity matched analysis
- Author
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Massimo Mancone, Gennaro Sardella, Maurizio D'Amico, Claudio Moretti, Géraud Souteyrand, P. Omede, Mario Iannaccone, Andrea Picchi, Massimo Fineschi, Nicolas Amabile, Enrico Cerrato, Fabrizio D'Ascenzo, Pascal Motreff, Ugo Limbruno, Giuseppe Biondi-Zoccai, Fiorenzo Gaita, Filippo Zilio, Fabrizio Ugo, Giampaolo Niccoli, Francesco Colombo, Roberto Garbo, Marco Ferlini, Alberto Cresti, Ovidio De Filippo, Stefano Rigattieri, Umberto Barbero, Antonio Maria Leone, Corrado Tamburino, Salvatore Colangelo, Antonio Montefusco, Universita della Tuscia, Istituto di Genio Rurale, Hôpital nord, St Etienne, CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Institut Pascal (IP), SIGMA Clermont (SIGMA Clermont)-Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Dipartimento de Matematica [Milano], Università degli Studi di Milano [Milano] (UNIMI), Groupe d'anthropologie scolastique/Equipe CRH (GAS-CRH), École des hautes études en sciences sociales (EHESS)-Centre National de la Recherche Scientifique (CNRS), Università degli studi della Tuscia [Viterbo], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), SIGMA Clermont (SIGMA Clermont)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), and Università degli Studi di Milano = University of Milan (UNIMI)
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,medicine.medical_treatment ,Subgroup analysis ,Fractional flow reserve ,030204 cardiovascular system & hematology ,Culprit ,acute coronary syndrome ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Registries ,030212 general & internal medicine ,Propensity Score ,fractional flow reserve ,medicine (all) ,ComputingMilieux_MISCELLANEOUS ,Aged ,Retrospective Studies ,optical coherence tomography ,Unstable angina ,business.industry ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Drug eluting stent ,Optical coherence tomography ,Cardiology and Cardiovascular Medicine ,3. Good health ,Fractional Flow Reserve, Myocardial ,Drug-eluting stent ,Conventional PCI ,Cardiology ,Female ,drug eluting stent ,cardiology and cardiovascular medicine ,business ,Tomography, Optical Coherence ,Follow-Up Studies - Abstract
To compare in patients with ACS (acute coronary syndromes) a PCI (percutaneous coronary intervention) approach based on FFR (fractional flow reserve) vs. one based on OCT (optical coherence tomography).Consecutive patients admitted for ACS and treated with a PCI approach based on OCT or on FFR (recruited in two different studies) were compared and matched with propensity score analysis. Target Lesion revascularization (TLR) was the primary end point, while major adverse cardiovascular events [MACEs defined as the composite of death from cardiac causes, non-fatal MI, clinically driven target vessel revascularization (TVR), or re-hospitalization due to unstable angina] were the secondary ones. Sub-group analysis was performed for patients with FFR/OCT performed on culprit lesions and not. 285 patients were enrolled in the OCT-guided group and 335 in the FFR-guided group, 197 for each being selected after propensity score. After 25months (range: 7-39months), OCT-guided group were exposed to lower incidence of TLR (4.1% vs. 14.2% p0.01) compared with FFR-guided group without impact on MACEs (14.2% vs. 14.2%, p=1) or all-cause death (3.6% vs. 1.1%, p=0.34). At Kaplan-Maier curve analysis for MACEs OCT-guided and FFR-guided groups showed similar outcomes (HR 1.19, CI 0.65-2.2, p=0.54). Subgroup analysis on culprit and not culprit vessel demonstrated consistent results.An OCT based approach in ACS patients offers a reduction in TLR when compared to a PCI-FFR driven. These findings should be confirmed in randomized controlled trial.
- Published
- 2017