Combining Optical Coherence Tomography and Fractional Flow Reserve for Decision Making in Percutaneous Coronary...

Physiological indices and intracoronary imaging provide additional and complementary information to coronary angiography, which may enhance procedural decision making during percutaneous coronary intervention (PCI). This study aimed to evaluate the impact of fractional flow reserve (FFR) and optical coherence tomography (OCT) on revascularization decision making and PCI strategy compared with angiography guidance alone.

In this secondary analysis from the prospective, observational FUSION (Validation of OCT-Based Functional Diagnosis of Coronary Stenosis) study, the impact of angiography, OCT, and FFR on procedural decision making was evaluated by comparing the intended treatment strategy after each step to the actual treatment strategy, which was left to the operator's discretion and was guided by the totality of diagnostic testing.

Among 224 patients (mean age, 67.4 ± 9.2 years; 30.8% women), 116 (51.8%) underwent coronary revascularization, while it was deferred in 108 (48.2%). Compared with the actual treatment strategy, the rate of intended revascularization was significantly higher when guided by angiography (62.5% vs 51.8%; P = .002) or OCT (66.5% vs 51.8%; P < .001), but similar when guided by FFR (53.6% vs 51.8%; P = .34). Among lesions undergoing PCI with available strategy information (n = 83), the intended stent size differed from the actual implanted stent size in 59.0% of cases based on angiography, compared with 12.1% of cases based on OCT findings (P < .001).

Fractional flow reserve and OCT provide distinct yet complementary information that significantly impacts decision making during PCI. Specifically, FFR informs revascularization decision making, while OCT plays a crucial role in device sizing. Combining anatomical, morphological, and physiological variables in a single modality may enhance decision making and reduce resource utilization.