Sex Differences in Fractional Flow Reserve- or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Clinical Trial Analysis

Background:

• Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is noninferior to intracoronary ultrasound (IVUS)-guided PCI.
• Previous trials demonstrated fewer revascularizations with FFR-guided PCI.

Purpose of the Study:

• To investigate sex differences in treatment and clinical outcomes.
• To compare physiology- (FFR) versus imaging- (IVUS) guided PCI strategies stratified by sex.

Main Methods:

• Secondary analysis of the FLAVOUR trial (n=1,619).
• Examined procedural characteristics, PCI rates, and target vessel failure (TVF) at 24 months.
• TVF defined as cardiac death, target vessel MI, or target vessel revascularization.

Main Results:

• Women (30%) had smaller lumen area, less plaque, and higher FFR than men.
• Women had lower PCI rates (40.8% vs 47.9%), primarily with FFR guidance.
• Women showed lower overall TVF rates (2.4% vs 4.5%), particularly with PCI deferral (1.7% vs 5.2%).

Conclusions:

• Women with intermediate stenosis experienced better outcomes than men, despite fewer interventions.
• FFR guidance reduced PCI rates without compromising prognostic value compared to IVUS.
• No significant differences in clinical outcomes between FFR- and IVUS-guided strategies were observed for either sex.