Discordance between Physiology and Imaging Guided PCI in Intermediate Coronary Lesions: Who to trust?

As regards intermediate coronary lesion intervention, physiological assessment is essential for culprit lesion identification and clinical decision making. It has been shown, in a randomized study, that physiology-guided percutaneous coronary intervention (PCI), along with intravascular ultrasound (IVUS), is not inferior for the combined two-year outcome of all-cause death, acute myocardial infarction (AMI), and revascularization.

Currently, the combination of these strategies is considered best practice. However, their discrepancies and clinical implications remain unclear.

The aim of this post-hoc analysis of the FLAVOUR study (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients with Intermediate Stenosis) was to evaluate the discrepancy and relevance of physiological assessment in IVUS-guided PCI.

The Primary Endpoint was major adverse cardiovascular events (MACE) incidence, defined as a composite of death, acute myocardial infarction (AMI), and revascularization, at one-year follow-up.

Read also: Edge-to-Edge Repair in Atrial Secondary Tricuspid Regurgitation.

The Secondary Endpoint included angina frequency and quality of life, a per the Seattle Angina Questionnaire. Patients were classified based on IVUS use for PCI guidance (performed vs. deferred PCI) and QFR value, as follows:

Deferred Group: Negative QFR + deferred PCI.

Performed Group: Negative QFR + performed PCI.

Reference Group: Positive QFR + performed PCI.

34.4% of the 784 analyzed patients belonged to the deferred group, 29.3% to the performed group, and 31.5% to the reference group. Mean age was approximately 65, and most participants were male. The most frequently treated coronary artery was the left anterior descending, followed by the right coronary.

Cumulative MACE incidence at two years was 4.5%, 3.9%, and 9.4% for the deferred, performed, and reference groups, respectively (P = 0.019). MACE risk resulted higher among reference group patients vs. the performed group (HR: 2.46; 95% CI: 1.13–5.35; P = 0.023) and the deferred group (HR: 2.17; 95% CI: 1.07–4.38; P = 0.031). 

Read also: Trends in the Treatment of Critical Lower Limb Ischemia.

In patients with negative QFR, there were no prognostic differences between the performed and deferred groups as regards MACE (HR: 0.88; 95% CI: 0.37–2.11; P = 0.779) or AMI (HR: 1.48; 95% CI: 0.49–4.45; P = 0.484), and neither were there differences in secondary end point.

Conclusión 

Angiography-based physiological assessment may provide additional prognostic information in patients undergoing IVUS-guided PCI. IVUS guided PCI may not be beneficial in patients with functionally non-significant lesions. This sub-analysis should serve as springboard to generate new hypotheses and continue to evaluate the combination of these two therapeutic tools.

Original Title: Clinical Relevance of Discordance Between Physiology-and Imaging Guided PCI Strategies in Intermediate Coronary Stenosis.

Reference: Jinlong Zhang,MD,PHD et al JACC Cardiovasc Interv 2024. 


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

Dr. Andrés Rodríguez
Dr. Andrés Rodríguez
Member of the Editorial Board of solaci.org

More articles by this author

RODIN-CUT: Successive Cutting Balloon Technique in Calcified Lesions

Moderate or severe coronary calcification can be a marker of poor prognosis in coronary artery disease, as it significantly increases the risk of failure...

Acute Coronary Syndrome with Multivessel Disease: Best Revascularization Strategy

The gold standard treatment for acute coronary syndrome (ACS), especially acute myocardial infarction (AMI) is primary angioplasty (PCI). However, 40 to 70% of ACS...

Improved Ejection Fraction in Chronic Total Occlusion?

Chronic total occlusions (CTO) represent a significant challenge in the current clinical practice, seeing as CTO percutaneous coronary intervention (PCI) is complex and involves...

Timing in Complete Revascularization in Acute Coronary Syndrome: BIOVASC 2-Year Followup

The concept of complete revascularization (CR) has been comprehensively studied, leading to diverse approaches and debates on optimal timing.  The BIOVASC trial explored the ideal...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

RODIN-CUT: Successive Cutting Balloon Technique in Calcified Lesions

Moderate or severe coronary calcification can be a marker of poor prognosis in coronary artery disease, as it significantly increases the risk of failure...

Acute Coronary Syndrome with Multivessel Disease: Best Revascularization Strategy

The gold standard treatment for acute coronary syndrome (ACS), especially acute myocardial infarction (AMI) is primary angioplasty (PCI). However, 40 to 70% of ACS...

Improved Ejection Fraction in Chronic Total Occlusion?

Chronic total occlusions (CTO) represent a significant challenge in the current clinical practice, seeing as CTO percutaneous coronary intervention (PCI) is complex and involves...