This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nam, C.-W. Articles by Kim, K.-B. Search for Related Content PubMed Articles by Nam, C.-W. Articles by Kim, K.-B. Related Collections Related Article

Outcomes of Percutaneous Coronary Intervention in Intermediate Coronary Artery Disease

Fractional Flow Reserve–Guided Versus Intravascular Ultrasound–Guided

Chang-Wook Nam, MD, PhD^_*, Hyuck-Jun Yoon, MD^_*, Yun-Kyeong Cho, MD, PhD^_*, Hyoung-Seob Park, MD^_*, Hyungseop Kim, MD, PhD^_*, Seung-Ho Hur, MD, PhD^_*, Yoon-Nyun Kim, MD, PhD^_*, In-Sung Chung, MD, PhD^_*, Bon-Kwon Koo, MD, PhD, Seung-Jae Tahk, MD, PhD, William F. Fearon, MD^,_*, Kwon-Bae Kim, MD, PhD^_*,_*

^_* Keimyung University Dongsan Medical Center, Daegu, Korea
Seoul National University Hospital, Seoul, Korea
Ajou University Hospital, Suwon, Korea
Stanford University Medical Center, Cardiovascular Medicine, Stanford, California

^_* Reprint requests and correspondence: Dr. Kwon-Bae Kim, Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, 194 Dongsan-dong, Jung-gu, Daegu 700-712, South Korea (Email: wfearon{at}stanford.edu; k5112{at}dsmc.or.kr).

^_* Dr. William F. Fearon, Division of Cardiovascular Medicine, Stanford University Medical Center, 300 Pasteur Drive, H3554, Stanford, California 94305 (Email: wfearon{at}stanford.edu; k5112{at}dsmc.or.kr).

Objectives: This study sought to evaluate the long-term clinical outcomes of a fractional flow reserve (FFR)–guided percutaneous coronary intervention (PCI) strategy compared with intravascular ultrasound (IVUS)–guided PCI for intermediate coronary lesions.

Background: Both FFR- and IVUS-guided PCI strategies have been reported to be safe and effective in intermediate coronary lesions.

Methods: The study included 167 consecutive patients, with intermediate coronary lesions evaluated by FFR or IVUS (FFR-guided, 83 lesions vs. IVUS-guided, 94 lesions). Cutoff value of FFR in FFR-guided PCI was 0.80, whereas that for minimal lumen cross sectional area in IVUS-guided PCI was 4.0 mm². The primary outcome was defined as a composite of major adverse cardiac events including death, myocardial infarction, and ischemia-driven target vessel revascularization at 1 year after the index procedure.

Results: Baseline percent diameter stenosis and lesion length were similar in both groups (51 ± 8% and 24 ± 12 mm in the FFR group vs. 52 ± 8% and 24 ± 13 mm in the IVUS group, respectively). However, the IVUS-guided group underwent revascularization therapy significantly more often (91.5% vs. 33.7%, p < 0.001). No significant difference was found in major adverse cardiac event rates between the 2 groups (3.6% in FFR-guided PCI vs. 3.2% in IVUS-guided PCI). Independent predictors for performing intervention were guiding device: FFR versus IVUS (relative risk [RR]: 0.02); left anterior descending coronary artery versus non-left anterior descending coronary artery disease (RR: 5.60); and multi- versus single-vessel disease (RR: 3.28).

Conclusions: Both FFR- and IVUS-guided PCI strategy for intermediate coronary artery disease were associated with favorable outcomes. The FFR-guided PCI reduces the need for revascularization of many of these lesions.

Key Words: coronary angiography • fractional flow reserve • intravascular ultrasound • outcome • percutaneous coronary intervention

Abbreviations and Acronyms   DES = drug-eluting stent(s)   FFR = fractional flow reserve   IVUS = intravascular ultrasound   LAD = left anterior descending coronary artery   MACE = major adverse cardiac event   MLA = minimal lumen area   PCI = percutaneous coronary intervention   TVR = target vessel revascularization

Related Article

If You Want to Stent ... Do Intravascular Ultrasound!

John McB. Hodgson
J. Am. Coll. Cardiol. Intv. 2010 3: 818-820. [Full Text] [PDF]

This article has been cited by other articles:

				G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, S. M. Hollenberg, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions J. Am. Coll. Cardiol., December 6, 2011; 58(24): e44 - e122. [Full Text] [PDF]

				Writing Committee Members, G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions Circulation, December 6, 2011; 124(23): e574 - e651. [Full Text] [PDF]

				S.-J. Kang, J.-Y. Lee, J.-M. Ahn, H. G. Song, W.-J. Kim, D.-W. Park, S.-C. Yun, S.-W. Lee, Y.-H. Kim, G. S. Mintz, et al. Intravascular Ultrasound-Derived Predictors for Fractional Flow Reserve in Intermediate Left Main Disease J. Am. Coll. Cardiol. Intv., November 1, 2011; 4(11): 1168 - 1174. [Abstract] [Full Text] [PDF]

				C.-W. Nam, F. Mangiacapra, R. Entjes, I.-S. Chung, J.-W. Sels, P. A. L. Tonino, B. De Bruyne, N. H. J. Pijls, W. F. Fearon, and FAME Study Investigators Functional SYNTAX Score for Risk Assessment in Multivessel Coronary Artery Disease J. Am. Coll. Cardiol., September 13, 2011; 58(12): 1211 - 1218. [Abstract] [Full Text] [PDF]

				A. Yehya and M. K. Mandawat Fractional Flow Reserve: A Review for Cardiac Catheterization Lab Personnel Cardiac Cath Lab Director, April 1, 2011; 1(2): 79 - 81. [PDF]

				J. M. Hodgson If You Want to Stent ... Do Intravascular Ultrasound! J. Am. Coll. Cardiol. Intv., August 1, 2010; 3(8): 818 - 820. [Full Text] [PDF]