Phenomapping-derived selection of fractional flow reserve or optical coherence tomography to personalise percutaneous coronary intervention.

IF 2.8 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Open Heart Pub Date : 2025-09-17 DOI:10.1136/openhrt-2025-003453

Fabrizio D'Ascenzo, Isabella Caranzano, Ovidio De Filippo, Federico Giacobbe, Antonio Maria Leone, Tiziana Sanavia, Emanuele Ravetti, Fabrizio Ugo, Carlo Trani, Nicolas Amabile, Samuele Sandrone, Cristina Aurigemma, Geraud Souteyrand, Davide Capodanno, Irene Borzillo, Francesco Bruno, Giacomo Boccuzzi, Piero Fariselli, Gaetano Maria De Ferrari, Mario Iannaccone, Francesco Burzotta

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引用次数: 0

Abstract

Introduction: An evidence-based selection between fractional flow reserve (FFR) and optical coherence tomography (OCT) to drive percutaneous coronary intervention is still lacking.

Methods: 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.

Results: 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).

Conclusions: 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.

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分流血流储备或光学相干断层成像的现象图衍生选择个体化经皮冠状动脉介入治疗。

基于证据的血流储备分数（FFR）和光学相干断层扫描（OCT）之间的选择，以驱动经皮冠状动脉介入治疗仍然缺乏。方法：纳入分流血流储备与光学相干断层扫描指导中间冠状动脉狭窄血运重建（FORZA）试验的患者，以及ACS患者罪犯和非罪犯冠状动脉斑块形态、组成和不稳定性的oct特征（OCT-FORMIDABLE）登记。靶血管重建（TVR）和主要心脏不良事件（MACE），心源性死亡、心肌梗死（MI）和TVR的复合终点被认为是主要终点。采用聚类法进行现象映射：根据FFR和OCT探讨结果的发生率。结果：405例患者按OCT治疗，405例按FFR治疗。确定了三个不同的群集。48%的患者被纳入第一组，主要表现为稳定型心绞痛和相关的危险因素负担（心血管危险因素，CVRFs）。21%的患者被纳入第二组，表现为ST段抬高型心肌梗死（STEMI）和低cvrf发生率。31%的患者主要因非stemi （NSTEMI）入院，且cvrf发生率高，被纳入第三组。FFR和OCT在第一组的MACE和TVR方面表现相似。在第二组中，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）。在第三组中，OCT组的TVR率显著降低（6%对14%，p 0.037），对MACE的影响中性（12%对15%，p 0.71）。结论：与功能评估相比，基于oct的方法可以减少STEMI/NSTEMI患者的血运重建，而对于稳定型心绞痛患者，FFR证明并不差。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Open Heart CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.60

自引率

3.70%

发文量

145

审稿时长

20 weeks

期刊介绍： Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.