[Effectiveness comparison of three detection methods in guiding percutaneous coronary intervention for coronary...

Objective: To compare the effectiveness of intravascular ultrasound (IVUS), fractional flow reserve (FFR) and resting cycle ratio (RFR) in guiding the treatment decision of coronary artery borderline lesions (BL). Methods: This study was a retrospective cohort study. A total of 730 BL patients hospitalized in the Fuwai Huazhong Cardiovascular Hospital, from January 2020 to May 2022 were selected as subjects. According to the examination methods, patients were divided into IVUS group (244 cases), FFR group (257 cases) and RFR group (229 cases). The minimum lumen area≤4 mm², FFR value≤0.80 and RFR value≤0.89 were used as the interventional treatment decision criteria. The proportion of percutaneous coronary intervention, surgical data, target vessel revascularization in two years after treatement and the incidence of major adverse cardiovascular events (MACE) were compared under the guidance of the three detection techniques. The survival curve was drawn using Kaplan-Meier method, and the log rank test was used for comparison between groups. The multivariate Cox proportional hazards regression model was used to analyze the related factors of target vessel revascularization and MACE. Results: The age of patients in IVUS group, FFR group and RFR group were (65.6±8.7), (64.8±9.7) and (65.3±9.4) years old, respectively, and the proportion of males was 52.46% (128 cases), 54.86% (141 cases) and 55.46% (127 cases), respectively. Multivariate regression analysis showed that FFR, RFR and conservative treatment were the related factors of target vessel revascularization risk in patients with BL, HR (95%CI) were 1.322 (1.156, 2.240), 1.336 (1.190, 3.142), 1.215 (1.102, 2.418), respectively; FFR, RFR, conservative treatment, coronary calcification score, and coronary stenosis rate were the related factors of adverse cardiovascular events in patients with BL, HR (95%CI) were 1.436 (1.185-1.792), 1.541 (1.313-1.848), 1.358 (1.198-1.792), 1.097 (1.003-1.316), 1.401 (1.206-2.492), respectively (all P<0.05). The median survival time of target vessel revascularization in IVUS group, FFR group and RFR group were 11.0, 14.5 and 14.0 months, respectively. The cumulative survival rates from target vessel revascularization were 98.77%, 94.94% and 95.63%, respectively (P=0.030); The median survival time of adverse cardiovascular events was 6.0, 14.5 and 14.0 months, respectively. The cumulative survival rates from adverse cardiovascular events were 96.72%, 91.05% and 91.27%, respectively (P=0.008). Conclusions: Compared with RFR and FFR guidance, IVUS detection demonstrates a higher rate of percutaneous coronary intervention intervention decision-making for BL, along with lower rates of target vessel revascularization and adverse cardiovascular events. Coronary artery calcium score and stenosis percentage are significant influencing factors for adverse cardiovascular outcomes in BL patients.