D'Ascenzo Fabrizio, Caranzano Isabella, De Filippo Ovidio, Giacobbe Federico, Leone Antonio Maria, Sanavia Tiziana, Ravetti Emanuele, Ugo Fabrizio, Trani Carlo, Amabile Nicolas, Sandrone Samuele, Aurigemma Cristina, Souteyrand Geraud, Capodanno Davide, Borzillo Irene, Bruno Francesco, Boccuzzi Giacomo, Fariselli Piero, De Ferrari Gaetano Maria, Iannaccone Mario, Burzotta Francesco
Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Piedmont, Italy.
AI and Computational Biomedicine Unit, Department of Medical Sciences, University of Turin, Turin, Piedmont, Italy.
Open Heart. 2025 Sep 17;12(2):e003453. doi: 10.1136/openhrt-2025-003453.
An evidence-based selection between fractional flow reserve (FFR) and optical coherence tomography (OCT) to drive percutaneous coronary intervention is still lacking.
Patients enrolled in the Fractional Flow Reserve vs. Optical Coherence Tomography to Guide Revascularization of Intermediate Coronary Stenoses (FORZA) trial and in the OCT-Features Of moRphology, coMposItion anD instABility of culprit and not culprit coronary pLaquE in ACS patient (OCT-FORMIDABLE) registry were included. Target vessel revascularisation (TVR) and major adverse cardiac events (MACE), a composite endpoint of cardiac death, myocardial infarction (MI) and TVR were considered as coprimary endpoints. Phenomapping with clustering was performed: incidence of outcomes according to FFR and OCT was explored.
405 patients were treated according to OCT and 405 to FFR. Three different clusters were identified. 48% of the patients were included in the first cluster, presenting mainly with stable angina and a relevant burden of risk factors (cardiovascular risk factors, CVRFs). 21% of the patients were included in the second cluster, presenting with ST segment elevation MI (STEMI) and with low rates of CVRFs. 31% of the patients, being admitted mostly for non-STEMI (NSTEMI) and with high rates of CVRFs, were included in the third cluster. FFR and OCT performed similarly in terms of MACE and TVR in the first cluster. In the second cluster, rates of MACE were lower in the OCT arm (3% vs 12%, p 0.04), mainly driven by TVR (2% vs 6%, p 0.18). In the third cluster, rates of TVR were significantly reduced in the OCT arm (6% vs 14%, p 0.037) with a neutral impact on MACE (12% vs 15%, p 0.71).
Compared with a functional assessment, an OCT-based approach reduces revascularisation in patients with STEMI/NSTEMI, while FFR proved non-inferior for patients with stable angina.
在分数流储备（FFR）和光学相干断层扫描（OCT）之间进行基于证据的选择以指导经皮冠状动脉介入治疗仍然缺乏依据。
纳入参与分数流储备与光学相干断层扫描指导中度冠状动脉狭窄血运重建（FORZA）试验以及急性冠状动脉综合征（ACS）患者罪犯和非罪犯冠状动脉斑块的形态、成分及不稳定性的光学相干断层扫描特征（OCT-FORMIDABLE）注册研究的患者。将靶血管血运重建（TVR）和主要不良心脏事件（MACE，心脏死亡、心肌梗死（MI）和TVR的复合终点）视为共同主要终点。进行聚类现象映射：探索根据FFR和OCT的结局发生率。
405例患者根据OCT进行治疗，405例根据FFR进行治疗。识别出三个不同的聚类。48%的患者被纳入第一聚类，主要表现为稳定型心绞痛且有相关的危险因素负担（心血管危险因素，CVRFs）。21%的患者被纳入第二聚类，表现为ST段抬高型心肌梗死（STEMI）且CVRFs发生率低。31%的患者主要因非ST段抬高型心肌梗死（NSTEMI）入院且CVRFs发生率高，被纳入第三聚类。在第一聚类中，FFR和OCT在MACE和TVR方面表现相似。在第二聚类中，OCT组的MACE发生率较低（3%对12%，p<0.04），主要由TVR驱动（2%对6%，p<0.18）。在第三聚类中，OCT组的TVR发生率显著降低（6%对14%，p = 0.037），对MACE有中性影响（12%对15%，p = 0.71）。
与功能评估相比，基于OCT的方法可减少STEMI/NSTEMI患者的血运重建，而FFR被证明对稳定型心绞痛患者非劣效。
