Angiography-Derived FFR Versus IVUS to Guide PCI According to Angiographic Lesion Characteristics

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Imaging

Background:

• Percutaneous coronary intervention (PCI) guidance using angiography-derived fractional flow reserve (AngioFFR) and intravascular ultrasound (IVUS) show comparable outcomes.
• AngioFFR guidance is linked to reduced PCI rates compared to IVUS.
• The comparative effectiveness of AngioFFR versus IVUS-guided PCI based on specific lesion characteristics is not well-defined.

Purpose of the Study:

• To evaluate the clinical effectiveness of AngioFFR-guided versus IVUS-guided PCI in relation to angiographic lesion complexity.
• To assess the impact of a composite lesion risk score on target vessel failure (TVF) and PCI rates in both guidance groups.

Main Methods:

• Post-hoc analysis of the FLAVOUR II trial involving 1,726 patients with significant coronary stenosis.
• Patients were randomized to AngioFFR- or IVUS-guided PCI.
• A composite lesion risk score was developed using diameter stenosis, lesion length, bifurcation, ostial location, and calcification.

Main Results:

• Overall TVF rates were similar between AngioFFR (2.4%) and IVUS (1.9%) groups (P=0.50).
• Higher composite lesion risk scores correlated with increased TVF risk, particularly in the AngioFFR group.
• AngioFFR guidance resulted in lower PCI rates for low-risk lesions (60.1% vs. 76.5%, P <0.001), while IVUS guidance showed better outcomes for high-risk lesions (5.1% vs. 1.9% TVF, P=0.010).

Conclusions:

• Lesion complexity, quantified by a composite risk score, influences PCI rates and TVF risk regardless of guidance strategy.
• AngioFFR guidance is associated with reduced PCI rates in low-risk coronary lesions.
• IVUS guidance may offer superior clinical outcomes for patients with high-risk coronary lesions.