1. Three-Year Clinical Impact of Murray Law-Based Quantitative Flow Ratio and OCT- or FFR-Guidance in Angiographically Intermediate Coronary Lesions.
- Author
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Aurigemma C, Ding D, Tu S, Li C, Yu W, Li Y, Leone AM, Romagnoli E, Vergallo R, Maino A, Trani C, Wijns W, and Burzotta F
- Subjects
- Humans, Male, Female, Aged, Treatment Outcome, Middle Aged, Time Factors, Prospective Studies, Cardiac Catheterization, Clinical Decision-Making, Severity of Illness Index, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease therapy, Coronary Artery Disease physiopathology, Risk Factors, Stents, Fractional Flow Reserve, Myocardial, Tomography, Optical Coherence, Coronary Angiography, Coronary Stenosis diagnostic imaging, Coronary Stenosis therapy, Coronary Stenosis physiopathology, Predictive Value of Tests, Percutaneous Coronary Intervention adverse effects, Coronary Vessels diagnostic imaging, Coronary Vessels physiopathology
- Abstract
Background: The FORZA trial (FFR or OCT Guidance to Revascularize Intermediate Coronary Stenosis Using Angioplasty) prospectively compared the use of fractional flow reserve (FFR) or optical coherence tomography (OCT) for treatment decisions and percutaneous coronary intervention (PCI) optimization in patients with angiographically intermediate coronary lesions. Murray law-based quantitative-flow-ratio (μQFR) is a novel noninvasive method for the computation of FFR. In the present study, we evaluated the clinical impact of μQFR, FFR, or OCT guidance in FORZA trial lesions at 3-year follow-up., Methods: μQFR was assessed at baseline and, in the case of a decision to intervene, after (FFR- or OCT-guided) PCI. The baseline μQFR was considered the final μQFR for deferred lesions, and post-PCI μQFR value was taken as final for stented lesions. The primary end point was target vessel failure ([TVF]; cardiac death, target-vessel-related myocardial infarction, and target-vessel-revascularization) at a 3-year follow-up., Results: A total of 419 vessels (199 OCT-guided and 220 FFR-guided) were included in the FORZA trial. μQFR was evaluated in 256 deferred lesions and 159 treated lesions (98 OCT-guided PCI and 61 FFR-guided PCI). In treated lesions, post-PCI μQFR was higher in OCT-group compared with FFR-group (median, 0.93 versus 0.91; P =0.023), and the post-PCI μQFR improvement was greater in FFR-group (0.14 versus 0.08; P <0.0001). At 3-year follow-up, OCT- and FFR-guided treatment decisions resulted in comparable TVF rate (6.7% versus 7.9%; P =0.617). Final μQFR was the only predictor of TVF. μQFR ≤0.89 was associated with 3× increase in TVF (11.6% versus 3.7%; P =0.004). PCI was a predictor of higher final μQFR (odds ratio, 0.22 [95% CI, 0.14-0.34]; P <0.001)., Conclusions: In vessels with angiographically intermediate coronary lesions, OCT-guided PCI resulted in comparable clinical outcomes as FFR-guided PCI. μQFR estimated at the end of diagnostic or interventional procedure predicted 3-year TVF., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01824030., Competing Interests: Disclosures Dr Wijns reports institutional research grants and past honoraria from MicroPort; senior advisor of Rede Optimus Research, Corrib Core Laboratory and co-founder of Argonauts, an innovation facilitator. Dr Tu is a co-founder of Pulse Medical and reports research grant and consultancy from Pulse Medical. Drs Burzotta, Trani, and Aurigemma received speaker’s fees from Abbott, Medtronic, Abiomed and Terumo. Dr Leone received speaking honoraria from St. Jude Medical/Abbott, Medtronic, Abiomed and from Bracco Imaging. The other authors report nop conflicts.
- Published
- 2024
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