Zito Andrea, Burzotta Francesco, Aurigemma Cristina, Romagnoli Enrico, Bianchini Francesco, Bianchini Emiliano, Paraggio Lazzaro, Lunardi Mattia, Ierardi Carolina, Crea Filippo, Leone Antonio Maria, Trani Carlo
Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: https://x.com/@AndreaZito66.
Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Rev Esp Cardiol (Engl Ed). 2025 Mar 17. doi: 10.1016/j.rec.2025.02.012.
The management of patients with coronary artery disease can benefit from devices that improve functional or anatomical evaluation. This study aimed to compare the efficacy of optical coherence tomography (OCT) and fractional flow reserve (FFR) guidance for managing vessels with angiographically intermediate coronary lesions according to angiographic lesion complexity.
The FORZA trial (NCT01824030) was a randomized trial comparing the use of OCT or FFR for revascularization decisions and percutaneous coronary intervention optimization in patients with angiographically intermediate coronary lesions. Complex lesions were defined as long (length >38mm), severely calcified, or bifurcation lesions. The primary outcome was major adverse cardiac events (MACE), defined as a composite of all-cause death, myocardial infarction, or target vessel revascularization.
A total of 420 vessels (200 OCT-guided and 220 FFR-guided) were enrolled, including 212 vessels with complex lesions. At the 5-year follow-up, the MACE rate was 20.8% in vessels with complex lesions and 13.9% in vessels with noncomplex lesions (HR, 1.52; 95%CI, 0.95-2.44; P=.078). Compared with FFR, OCT was associated with a lower risk of MACE in vessels with complex lesions (HR, 0.53; 95%CI, 0.28-0.98; P=.044), but with a higher risk of MACE in vessels with noncomplex lesions (HR, 2.23; 95%CI, 1.04-4.81; P=.040; P=.004).
In vessels with angiographically intermediate coronary lesions, angiographic lesion complexity may modulate the long-term efficacy of the guidance modality, with a potential benefit of OCT in complex lesions and FFR in noncomplex lesions.
冠状动脉疾病患者的管理可受益于能够改善功能或解剖评估的设备。本研究旨在根据血管造影病变复杂性，比较光学相干断层扫描（OCT）和血流储备分数（FFR）指导处理冠状动脉造影显示为中等病变血管的疗效。
FORZA试验（NCT01824030）是一项随机试验，比较在冠状动脉造影显示为中等病变的患者中，使用OCT或FFR进行血运重建决策及优化经皮冠状动脉介入治疗的情况。复杂病变定义为长病变（长度>38mm）、严重钙化病变或分叉病变。主要结局是主要不良心脏事件（MACE），定义为全因死亡、心肌梗死或靶血管血运重建的复合事件。
共纳入420条血管（200条由OCT指导，220条由FFR指导），其中包括212条复杂病变血管。在5年随访时，复杂病变血管的MACE发生率为20.8%，非复杂病变血管为13.9%（风险比[HR]，1.52；95%置信区间[CI]，0.95 - 2.44；P = 0.078）。与FFR相比，OCT在复杂病变血管中与较低的MACE风险相关（HR，0.53；95%CI，0.28 - 0.98；P = 0.044），但在非复杂病变血管中与较高的MACE风险相关（HR，2.23；95%CI，1.04 - 4.81；P = 0.040；P = 0.004）。
在冠状动脉造影显示为中等病变的血管中，血管造影病变复杂性可能会调节指导方式的长期疗效，OCT在复杂病变中可能有益，而FFR在非复杂病变中可能有益。
