Groenland Frederik T W, Neleman Tara, Ziedses des Plantes Annemieke C, Scoccia Alessandra, Kardys Isabella, den Dekker Wijnand K, Wilschut Jeroen M, Diletti Roberto, Van Mieghem Nicolas M, Daemen Joost
Department of (Interventional) Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
Catheter Cardiovasc Interv. 2025 Jul;106(1):12-22. doi: 10.1002/ccd.31357. Epub 2024 Dec 25.
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.
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.
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 mm, p = 0.46) and MSA (0.29 vs. 0.32 mm, 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).
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.
在经皮冠状动脉介入治疗（PCI）后，血管内超声（IVUS）引导下对次优血流储备分数（FFR）进行优化，可使PCI术后的FFR以及最小管腔面积和支架面积（分别为MLA和MSA）显著增加。然而，非ST段抬高型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。
这是一项对FFR REACT试验的预设亚组分析，该试验比较了291例PCI术后FFR<0.90的患者在IVUS引导下进行PCI优化与不进行进一步治疗的情况。比较了NSTE-ACS患者与CCS患者的PCI术后生理学和优化前IVUS检查结果，以及优化策略、最终FFR和IVUS检查结果。
在291例患者中，130例（44.7%）表现为NSTE-ACS。NSTE-ACS患者和CCS患者的PCI术后FFR中位数相似（均为0.85，p=0.55）。两组之间优化前的IVUS检查结果无显著差异，随后的优化策略具有可比性（p=0.71）。在NSTE-ACS和CCS患者中，优化均使FFR中位数（0.02对0.03，p=0.80）、MLA（0.37对0.50mm，p=0.46）和MSA（0.29对0.32mm，p=0.61）有相似幅度的显著增加（所有p<0.01）。基于临床表现，IVUS引导下优化对2年靶血管失败的临床影响未显示出异质性迹象（交互作用p=0.36）。
在接受FFR指导的IVUS引导下优化的患者中，NSTE-ACS患者和CCS患者的PCI术后FFR、优化前IVUS检查结果和优化策略无显著差异，FFR、MLA和MSA的改善相当。
