한빛사논문
- 조회273
Seokhun Yang, MD1; Jeehoon Kang, MD1; Doyeon Hwang, MD1; Jinlong Zhang, MD, PhD2; Jun Jiang, MD2; Xinyang Hu, MD, PhD2; Joo-Yong Hahn, MD, PhD3; Chang-Wook Nam, MD, PhD4; Joon-Hyung Doh, MD, PhD5; Bong-Ki Lee, MD6; Weon Kim, MD7; Jinyu Huang, MD8; Fan Jiang, MD9; Hao Zhou, MD10; Peng Chen, MD11; Lijiang Tang, MD12; Wenbing Jiang, MD13; Xiaomin Chen, MD14; Wenming He, MD15; Sung Gyun Ahn, MD16; Myeong-Ho Yoon, MD17; Ung Kim, MD18; Joo Myung Lee, MD, PhD3; You-Jeong Ki, MD, PhD19; Eun-Seok Shin, MD, PhD20; Hyo-Soo Kim, MD, PhD1; Seung-Jea Tahk, MD, PhD17; Jian’an Wang, MD, PhD2; Bon-Kwon Koo, MD, PhD1
1Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
2The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
3Samsung Medical Center, Seoul, Republic of Korea
4Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
5Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
6Kangwon National University Hospital, Chuncheon, Gangwon-Do, Republic of Korea
7Kyung Hee University Hospital, Seoul, Republic of Korea
8Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
9Hangzhou Normal University Affiliated Hospital, Hangzhou, China
10The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
11The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
12Zhejiang Hospital, Hangzhou, China
13The Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou, China
14Ningbo First Hospital, Ningbo, China
15The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
16Wonju Severance Christian Hospital, Wonju, Gangwon-Do, Republic of Korea
17Ajou University Hospital, Suwon, Republic of Korea
18Yeungnam University Medical Center, Daegu, Republic of Korea
19Uijeongbu Eulji Medical Center, Uijeongbu, Gyeonggi-Do, Republic of Korea
20Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
Drs Yang and Kang contributed equally to this work as co–first authors.
Corresponding Author: Bon-Kwon Koo, MD, PhD
Abstract
Importance: Treatment strategies for intermediate coronary lesions guided by fractional flow reserve (FFR) and intravascular ultrasonography (IVUS) have shown comparable outcomes. Identifying low-risk deferred vessels to ensure the safe deferral of percutaneous coronary intervention (PCI) and high-risk revascularized vessels that necessitate thorough follow-up can help determine optimal treatment strategies.
Objectives: To investigate outcomes according to treatment types and FFR and IVUS parameters after FFR- or IVUS-guided treatment.
Design, setting, and participants: This cohort study included patients with intermediate coronary stenosis from the Fractional Flow Reserve and Intravascular Ultrasound-Guided Intervention Strategy for Clinical Outcomes in Patients With Intermediate Stenosis (FLAVOUR) trial, an investigator-initiated, prospective, open-label, multicenter randomized clinical trial that assigned patients into an IVUS-guided strategy (which recommended PCI for minimum lumen area [MLA] ≤3 mm2 or 3 mm2 to 4 mm2 with plaque burden [PB] ≥70%) or an FFR-guided strategy (which recommended PCI for FFR ≤0.80). Data were analyzed from November to December 2022.
Exposures: FFR or IVUS parameters within the deferred and revascularized vessels.
Main outcomes and measures: The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, and revascularization at 2 years.
Results: A total of 1619 patients (mean [SD] age, 65.1 [9.6] years; 1137 [70.2%] male) with 1753 vessels were included in analysis. In 950 vessels for which revascularization was deferred, incidence of TVF was comparable between IVUS and FFR groups (3.8% vs 4.1%; P = .72). Vessels with FFR greater than 0.92 in the FFR group and MLA greater than 4.5 mm2 or PB of 58% or less in the IVUS group were identified as low-risk deferred vessels, with a decreased risk of TVF (hazard ratio [HR], 0.25 [95% CI, 0.09-0.71]; P = .009). In 803 revascularized vessels, the incidence of TVF was comparable between IVUS and FFR groups (3.6% vs 3.7%; P = .95), which was similar in the revascularized vessels undergoing PCI optimization (4.2% vs 2.5%; P = .31). Vessels with post-PCI FFR of 0.80 or less in the FFR group or minimum stent area of 6.0 mm2 or less or with PB at stent edge greater than 58% in the IVUS group had an increased risk for TVF (HR, 7.20 [95% CI, 3.20-16.21]; P < .001).
Conclusions and relevance: In this cohort study of patients with intermediate coronary stenosis, FFR- and IVUS-guided strategies showed comparable outcomes in both deferred and revascularized vessels. Binary FFR and IVUS parameters could further define low-risk deferred vessels and high-risk revascularized vessels.
논문정보
- Research article
- 2024년 01월 (BRIC 등록일 2024-01-04)
- 국내(교신)+국외 연구진
- 의약학 > 응용의학
댓글 작성 로그인
팝업 닫기관련 링크
연구자 키워드
연구자 ID
관련분야 연구자보기
소속기관 논문보기
관련분야 논문보기
해당논문 저자보기
