Fractional Flow Reserve Directed Percutaneous Coronary Intervention Optimization Using High-Definition Intravascular Ultrasound in Non-ST-Segment Elevation Acute Coronary Syndrome Versus Chronic Coronary Syndrome.

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2024-12-25 DOI:10.1002/ccd.31357

Frederik T W Groenland, Tara Neleman, Annemieke C Ziedses des Plantes, Alessandra Scoccia, Isabella Kardys, Wijnand K den Dekker, Jeroen M Wilschut, Roberto Diletti, Nicolas M Van Mieghem, Joost Daemen

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Abstract

Background: Intravascular ultrasound (IVUS)-guided optimization of suboptimal fractional flow reserve (FFR) following percutaneous coronary intervention (PCI) results in a significant increase in both post-PCI FFR and minimal lumen and stent areas (MLA and MSA, respectively). However, the impact of clinical presentation with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) versus chronic coronary syndrome (CCS) on the efficacy of PCI optimization remains unknown.

Methods: This was a prespecified subgroup analysis of the FFR REACT trial comparing IVUS-guided PCI optimization versus no further treatment in 291 patients with a post-PCI FFR < 0.90. Post-PCI physiology and pre optimization IVUS findings were compared between patients presenting with NSTE-ACS versus CCS, as well as optimization strategy, final FFR and IVUS findings.

Results: Out of 291 patients, 130 (44.7%) presented with NSTE-ACS. Median post-PCI FFR was similar in patients with NSTE-ACS and CCS (0.85 for both, p = 0.55). Pre optimization IVUS findings did not differ significantly between both groups and subsequent optimization strategy was comparable (p = 0.71). In both NSTE-ACS and CCS, optimization resulted in a significant increase (p < 0.01 for all) of similar magnitude in median FFR (0.02 vs. 0.03, p = 0.80), MLA (0.37 vs. 0.50 mm², p = 0.46) and MSA (0.29 vs. 0.32 mm², p = 0.61), respectively. The clinical impact of IVUS-guided optimization on 2-year target vessel failure showed no signs of heterogeneity based on clinical presentation (interaction p = 0.36).

Conclusions: In patients undergoing FFR-directed IVUS-guided optimization, post-PCI FFR, pre optimization IVUS findings and optimization strategy did not differ significantly between patients presenting with either NSTE-ACS or CCS, with comparable improvements in FFR, MLA and MSA.

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在非st段抬高急性冠状动脉综合征与慢性冠状动脉综合征中应用高分辨率血管内超声优化分流储备定向经皮冠状动脉介入治疗

背景：经皮冠状动脉介入治疗（PCI）后，血管内超声（IVUS）引导的次优血流储备分数（FFR）优化导致PCI后FFR和最小管腔和支架面积（分别为MLA和MSA）显著增加。然而，非st段抬高急性冠状动脉综合征（NSTE-ACS）与慢性冠状动脉综合征（CCS）的临床表现对PCI优化疗效的影响尚不清楚。方法：这是一个预先指定的FFR REACT试验的亚组分析，比较了ivus引导的PCI优化与不进一步治疗的291例PCI后FFR患者。结果：291例患者中，130例（44.7%）出现NSTE-ACS。NSTE-ACS和CCS患者pci后FFR中位数相似（均为0.85,p = 0.55）。优化前IVUS结果在两组之间无显著差异，随后的优化策略具有可比性（p = 0.71）。在NSTE-ACS和CCS中，优化导致MSA分别显著增加（p 2, p = 0.46）和（0.29 vs. 0.32 mm2, p = 0.61）。ivus引导优化对2年靶血管衰竭的临床影响在临床表现上没有异质性（相互作用p = 0.36）。结论：在接受FFR导向IVUS引导优化的患者中，pci后FFR、优化前IVUS结果和优化策略在NSTE-ACS或CCS患者之间没有显著差异，FFR、MLA和MSA均有相当的改善。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.