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Fractional Flow Reserve or Optical Coherence Tomography to Guide Management of Angiographically Intermediate Coronary Stenosis: A Single-Center Trial.
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2020 Jan 13; Vol. 13 (1), pp. 49-58. - Publication Year :
- 2020
-
Abstract
- Objectives: The aim of this study was to compare optical coherence tomographic (OCT) guidance and fractional flow reserve (FFR) guidance in patients with angiographically intermediate coronary lesions (AICLs) in a single-center, prospective, 1:1 randomized trial.<br />Background: FFR and OCT imaging may help both in the assessment of AICLs and in percutaneous coronary intervention optimization.<br />Methods: Patients with AICLs were randomized to FFR or OCT imaging. In the FFR arm, PCI was performed if FFR was ≤0.80. In the OCT imaging arm, PCI was performed if area stenosis was ≥75% or 50% to 75% with minimal luminal area <2.5 mm <superscript>2</superscript> or plaque rupture. Angina (evaluated using the Seattle Angina Questionnaire), major adverse cardiac events, and cost were assessed at the end of follow-up. The pre-defined primary endpoint was the composite of major adverse cardiac events or significant angina (defined as Seattle Angina Questionnaire frequency scale score <90) at 13 months.<br />Results: A total of 350 patients (with 446 AICLs) were enrolled (176 randomized to FFR and 174 to OCT imaging). The primary endpoint of major adverse cardiac events or significant angina at 13 months occurred in 14.8% of patients in the FFR arm and in 8.0% in the OCT imaging arm (p = 0.048). This result was driven by a statistically nonsignificant lower occurrence of all primary endpoint components. Up to 13 months, the rate of medically managed patients was significantly higher (p < 0.001) and total cost significantly lower (p < 0.001) with FFR in comparison with OCT imaging.<br />Conclusions: In patients with AICLs, OCT guidance is associated with lower occurrence of the composite of major adverse cardiac events or significant angina. FFR guidance is associated with a higher rate of medical management and lower costs. FFR or OCT Guidance to Revascularize Intermediate Coronary Stenosis Using Angioplasty [FORZA]; NCT01824030).<br /> (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Cardiovascular Agents adverse effects
Cardiovascular Agents economics
Clinical Decision-Making
Coronary Stenosis economics
Coronary Stenosis physiopathology
Cost Savings
Cost-Benefit Analysis
Female
Health Care Costs
Humans
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Reproducibility of Results
Rome
Severity of Illness Index
Time Factors
Treatment Outcome
Cardiac Catheterization economics
Cardiovascular Agents therapeutic use
Coronary Stenosis diagnostic imaging
Coronary Stenosis therapy
Fractional Flow Reserve, Myocardial drug effects
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention economics
Tomography, Optical Coherence economics
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 13
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 31918942
- Full Text :
- https://doi.org/10.1016/j.jcin.2019.09.034