Johnson Thomas W, Bergmark Brian A, Croce Kevin, Pellegrini Dario, Maehara Akiko, Gori Tommaso, Pinilla-Echeverri Natalia, Wollmuth Jason, Gonzalo Nieves, Kao Hsien-Li, Guagliumi Giulio, Phalakornkule Kanitha, Ediebah Divine, McNutt JoAnna, Chiu Wei-Che, Op den Buijs Jorn, Buccola Jana, Landmesser Ulf, Ali Ziad, Stone Gregg W, Jeremias Allen
University of Bristol, Bristol, England, United Kingdom.
CTO/Complex Coronary Intervention Program, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; TIMI Study Group, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2025 Jul 15;86(2):93-102. doi: 10.1016/j.jacc.2025.05.019. Epub 2025 May 22.
A novel optical coherence tomography (OCT)-based physiology assessment technique, virtual flow reserve (VFR), has been demonstrated to perform as a reliable surrogate for invasive physiology.
The authors sought to examine the performance of post-percutaneous coronary intervention (PCI) VFR as a predictor of 2-year clinical outcomes independent from the OCT-based minimal stent area (MSA).
The ILUMIEN IV (Optical Coherence Tomography [OCT] Guided Coronary Stent Implantation Compared With Angiography: A Multicenter Randomized Trial in PCI) trial prospectively recruited 2,487 patients with diabetes or high-risk coronary lesions randomizing to OCT- vs angiography-guided drug-eluting stent implantation. All patients with single-lesion treatment who had a final OCT imaging available underwent retrospective post-PCI VFR analysis offline. Of 2,128 eligible patients, VFR analysis was successfully performed in 2,057 (96.6%). Independent OCT predictors for the primary endpoint of 2-year target vessel failure (TVF), a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target vessel revascularization, were evaluated by multivariable analysis.
The median post-PCI VFR was 0.90 (Q1-Q3: 0.86-0.92), with a significant difference in VFR observed between the angiography- and OCT-guided groups (0.89 [Q1-Q3: 0.86-0.92] vs 0.90 [Q1-Q3: 0.87-0.92]; P < 0.001). By multivariable analysis, both MSA (per 1 mm) and VFR (per 0.1 mm Hg/mm Hg) were independent predictors of 2-year TVF. Overall, MSA, proximal edge dissection and VFR independently predicted both TVF and target lesion failure.
Post-PCI OCT-based VFR assessment is predictive of 2-year clinical outcomes independent of MSA. Online VFR analysis can provide operators with an immediate assessment of post-PCI physiology in addition to OCT anatomy, providing incremental value in assessing procedural success and informing on clinical prognosis (ILUMIEN IV [Optical Coherence Tomography (OCT) Guided Coronary Stent Implantation Compared With Angiography: A Multicenter Randomized Trial in PCI]; NCT03507777).
一种基于新型光学相干断层扫描（OCT）的生理学评估技术——虚拟血流储备（VFR），已被证明可作为侵入性生理学的可靠替代指标。
作者试图研究经皮冠状动脉介入治疗（PCI）后VFR作为2年临床结局预测指标的性能，该指标独立于基于OCT的最小支架面积（MSA）。
ILUMIEN IV（光学相干断层扫描[OCT]引导的冠状动脉支架植入与血管造影术比较：PCI多中心随机试验）前瞻性招募了2487例糖尿病或高危冠状动脉病变患者，随机分为OCT引导组和血管造影术引导组进行药物洗脱支架植入。所有接受单病变治疗且有最终OCT成像的患者均进行了PCI术后VFR离线回顾性分析。在2128例符合条件的患者中，2057例（96.6%）成功进行了VFR分析。通过多变量分析评估了2年靶血管失败（TVF）这一主要终点的独立OCT预测指标，TVF是心脏死亡、靶血管心肌梗死和缺血驱动的靶血管血运重建的综合指标。
PCI术后VFR的中位数为0.90（第一四分位数-第三四分位数：0.86-0.92），血管造影术引导组和OCT引导组之间的VFR存在显著差异（0.89[第一四分位数-第三四分位数：0.86-0.92]对0.90[第一四分位数-第三四分位数：0.87-0.92]；P<0.001）。通过多变量分析，MSA（每1mm）和VFR（每0.1mmHg/mmHg）均为2年TVF的独立预测指标。总体而言，MSA、近端边缘夹层和VFR独立预测TVF和靶病变失败。
基于PCI术后OCT的VFR评估可独立于MSA预测2年临床结局。在线VFR分析除了能提供OCT解剖结构外，还能为操作者提供PCI术后生理学的即时评估，在评估手术成功率和告知临床预后方面具有额外价值（ILUMIEN IV[光学相干断层扫描（OCT）引导的冠状动脉支架植入与血管造影术比较：PCI多中心随机试验]；NCT03507777）。
