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Rate of stenting significantly higher for IVUS PCI vs. fractional flow reserve PCI in patients with intermediate CAD
Hodgson JM. J Am Coll Cardiol Intv. 2010;3:818-820.
Nam C. J Am Coll Cardiol Intv. 2010;3:812-817.
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Patients with coronary artery disease treated with fractional flow reserve-guided percutaneous coronary intervention and intravascular ultrasound-guided percutaneous coronary intervention had favorable clinical outcomes; however, the rate of performed percutaneous coronary intervention in intermediate coronary lesions was nearly three times lower in the fractional flow reserve arm without any increase of adverse events, according to study results.
Researchers evaluated coronary lesions with fractional flow reserve (FFR; n=83 lesions) and IVUS-guided (n=94 lesions) PCI in 167 consecutive patients. Cutoff value of FFR was 0.80, whereas the cutoff value for minimal lumen cross-sectional area in the IVUS-guided group was 4 mm². The primary outcome was a composite of major adverse cardiac events, which included death, MI and ischemia-driven target vessel revascularization 1 year after the index procedure.
Researchers reported similarities in baseline percent diameter stenosis (FFR, 51 ±8% vs. IVUS, 52 ±8%) and lesion length (FFR, 24 ±12 mm vs. IVUS, 24 ±13 mm); however, the IVUS-guided group underwent revascularization therapy almost threefold more often (91.5% vs. 33.7%, P<.001). Additionally, there was no significant difference in major adverse coronary events between groups.
John M. Hodgson, MD, department of cardiology, Geisinger Health System in Wilkes-Barre, Pa., said in an accompanying editorial that this study validates the statement that if you want to justify placing a stent, use IVUS to assess the lesion, and if you prefer medical therapy, use FFR to assess the lesion.
“The rate of stenting was three times higher in the IVUS-assessed group. This result is expected based on our understanding of fluid dynamics and coronary lesions,” he wrote. “The most important finding of this study, however, is that once again, physiologically FFR-guided decisions regarding PCI are safe and yield excellent patient outcomes. After all, ensuring excellent patient outcome with appropriate resource utilization (ie, cost-effectiveness) is our prime responsibility.”
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