Deferred PCI equally safe whether treatment decision based on IVUS or FFR: Study

Findings from the post-hoc analysis of 2-year data from the FLAVOUR trial were presented at the 2022 American College of Cardiology meeting and subsequently published online in Circulation: Cardiovascular Interventions.

In real-world practice, operators sometimes use IVUS in this way for left main lesions. However, FFR is considered a gold standard for treatment decision-making for most non-left main lesions, and this remains the case following FLAVOUR.

There is a continued accruing of positive data showing the benefits of intravascular imaging over angiography as a way to optimize stent placement. Still, controversy remains about whether these tools are warranted in all cases. Joo Myung Lee, Sungkyunkwan University School of Medicine, Seoul, Korea, and colleagues sought to compare the prognosis between deferred lesions based on IVUS and FFR-guided treatment decisions.

The researchers conducted a post hoc analysis of the FLAVOUR randomized trial that compared 2-year clinical outcomes between IVUS- and FFR-guided treatment decisions on intermediate coronary artery lesions using predefined criteria. In both the FFR and IVUS groups, vessels were classified into deferred or revascularized vessels, and patients were classified as those with or without deferred lesions.

Vessel-oriented composite outcomes (target vessel revascularization, target vessel myocardial infarction, or cardiac death) in deferred vessels and patient-oriented composite outcomes (myocardial infarction, death, or any revascularization) in patients with deferred lesions were compared between the IVUS and FFR groups.

The researchers reported the following findings:

• A total of 1682 patients and 1820 vessels were analyzed, of which 922 patients and 989 vessels were deferred.
• At 2 years, there was no difference in the cumulative incidence of vessel-oriented composite outcomes in deferred vessels between IVUS (n=375) and FFR (n=614) groups (3.8% versus 4.1%; hazard ratio, 0.91).
• The risk of vessel-oriented composite outcomes was comparable between deferred and revascularized vessels following treatment decision by IVUS (3.8% versus 3.5%; hazard ratio, 1.09) and FFR (4.1% versus 3.6%; hazard ratio, 1.14).
• In the comparison of patient-oriented composite outcomes in patients with deferred lesions, there was no significant difference between the IVUS (n=357) and FFR (n=565) groups (6.2% versus 5.9%; hazard ratio, 1.05).

“Patients whose PCI is deferred do equally well whether that’s a decision based on fractional flow reserve or intravascular ultrasound,” the researchers concluded.

The researchers suggest that FFR for treatment decision-making and IVUS for procedural optimization would be the best strategy for PCI. However, IVUS use for treatment decision-making and procedural optimization may be an alternative, especially cost-wise.

Reference:

Lee JM, Kim H, Hong D, Hwang D, Zhang J, Hu X, Jiang J, Nam CW, Doh JH, Lee BK, Kim W, Huang J, Jiang F, Zhou H, Chen P, Tang L, Jiang W, Chen X, He W, Kang J, Ahn SG, Yoon MH, Kim U, Ki YJ, Shin ES, Choi KH, Park TK, Yang JH, Song YB, Choi SH, Gwon HC, Koo BK, Kim HS, Tahk SJ, Wang J, Hahn JY; FLAVOUR Investigators. Clinical Outcomes of Deferred Lesions by IVUS Versus FFR-Guided Treatment Decision. Circ Cardiovasc Interv. 2023 Nov 29:e013308. doi: 10.1161/CIRCINTERVENTIONS.123.013308. Epub ahead of print. PMID: 38018840.