Fractional Flow Reserve or Optical Coherence Tomography to Guide Management of Angiographically Intermediate Coronary Stenosis: A Single-Center Trial

JACC Cardiovasc Interv. 2020 Jan 13;13(1):49-58. doi: 10.1016/j.jcin.2019.09.034.

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.

Background: FFR and OCT imaging may help both in the assessment of AICLs and in percutaneous coronary intervention optimization.

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 mm2 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.

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.

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).

Keywords: FFR; OCT; PCI; fractional flow reserve; optical coherence tomography; percutaneous coronary interventions; personalized medicine.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiac Catheterization* / economics
  • Cardiovascular Agents / adverse effects
  • Cardiovascular Agents / economics
  • Cardiovascular Agents / therapeutic use*
  • Clinical Decision-Making
  • Coronary Stenosis / diagnostic imaging*
  • Coronary Stenosis / economics
  • Coronary Stenosis / physiopathology
  • Coronary Stenosis / therapy*
  • Cost Savings
  • Cost-Benefit Analysis
  • Female
  • Fractional Flow Reserve, Myocardial / drug effects*
  • Health Care Costs
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / economics
  • Predictive Value of Tests
  • Prospective Studies
  • Reproducibility of Results
  • Rome
  • Severity of Illness Index
  • Time Factors
  • Tomography, Optical Coherence* / economics
  • Treatment Outcome

Substances

  • Cardiovascular Agents

Associated data

  • ClinicalTrials.gov/NCT01824030