{"title":"Angiography-Derived FFR Versus IVUS to Guide PCI According to Angiographic Lesion Characteristics.","authors":"Seokhun Yang, Xinyang Hu, Jinlong Zhang, Jin-Eun Song, Jun Jiang, Xiaoping Peng, Dongsheng Lu, Yibin Pan, Lijun Guo, Jilin Li, Wenming He, Hao Zhou, Jun Pu, Jinyu Huang, Fan Jiang, Qiang Liu, Daqing Song, Liang Lu, Zhenfeng Cheng, Bin Yang, Jianliang Ma, Peng Chen, Shiqiang Li, Zhaohui Meng, Lijiang Tang, Yongzhen Fan, Eun-Seok Shin, Shenxian Tu, Chang-Wook Nam, William F Fearon, Jian'an Wang, Bon-Kwon Koo","doi":"10.1161/CIRCINTERVENTIONS.126.016809","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>While angiography-derived fractional flow reserve (AngioFFR)- and intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) yield similar outcomes, with AngioFFR associated with lower PCI rates, the relative clinical effectiveness of AngioFFR versus IVUS-guided PCI according to angiographic lesion characteristics remains unclear.</p><p><strong>Methods: </strong>This post hoc analysis of the FLAVOUR II trial (Comparison of Angiography-Derived Fractional Flow Reserve- and Intravascular Ultrasound-Guided Intervention Strategy for Clinical Outcomes in Patients with Coronary Artery Disease) included patients with ≥50% stenosis randomized to AngioFFR- or IVUS-guided PCI. A composite lesion risk score was derived using a marginal Cox model-based linear predictor incorporating % diameter stenosis, lesion length, true bifurcation, ostial lesion, and heavy calcification. The primary end point was target vessel failure (TVF: cardiac death, target vessel myocardial infarction, and target vessel revascularization).</p><p><strong>Results: </strong>Among 1726 patients, 884 (51.2%) underwent AngioFFR-guided PCI and 842 (48.8%) underwent IVUS-guided PCI. During a median 12-month follow-up, TVF occurred in 2.4% of AngioFFR-treated vessels and 1.9% of IVUS-treated vessels (<i>P</i>=0.50). TVF risk increased progressively with a higher composite lesion risk score (adjusted hazard ratio, 2.76 [95% CI, 1.35-5.65]). This association was more pronounced in the AngioFFR group (adjusted hazard ratio, 3.93 [95% CI, 1.79-8.63]) than in the IVUS group (adjusted hazard ratio, 1.62 [95% CI, 0.42-6.22]). Compared with IVUS guidance, AngioFFR-guided vessels with high-risk lesions (score >0.32) had a higher TVF rate (5.1% versus 1.9%; <i>P</i>=0.010), whereas outcomes were comparable in those with low-risk lesions (1.5% versus 1.9%; <i>P</i>=0.531). AngioFFR guidance was associated with lower target vessel PCI rates in low-risk lesions (60.1% versus 76.5%; <i>P</i><0.001), whereas PCI rates were uniformly high and similar between groups in high-risk lesions (96.4% versus 97.4%; <i>P</i>=0.675).</p><p><strong>Conclusions: </strong>A higher composite lesion risk score was associated with increased PCI rates and TVF risk after AngioFFR- or IVUS-guided treatment. AngioFFR guidance was associated with lower PCI rates in low-risk lesions, whereas IVUS guidance may yield more favorable outcomes in high-risk lesions.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04397211.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016809"},"PeriodicalIF":7.2000,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574350/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.016809","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/5/19 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: While angiography-derived fractional flow reserve (AngioFFR)- and intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) yield similar outcomes, with AngioFFR associated with lower PCI rates, the relative clinical effectiveness of AngioFFR versus IVUS-guided PCI according to angiographic lesion characteristics remains unclear.
Methods: This post hoc analysis of the FLAVOUR II trial (Comparison of Angiography-Derived Fractional Flow Reserve- and Intravascular Ultrasound-Guided Intervention Strategy for Clinical Outcomes in Patients with Coronary Artery Disease) included patients with ≥50% stenosis randomized to AngioFFR- or IVUS-guided PCI. A composite lesion risk score was derived using a marginal Cox model-based linear predictor incorporating % diameter stenosis, lesion length, true bifurcation, ostial lesion, and heavy calcification. The primary end point was target vessel failure (TVF: cardiac death, target vessel myocardial infarction, and target vessel revascularization).
Results: Among 1726 patients, 884 (51.2%) underwent AngioFFR-guided PCI and 842 (48.8%) underwent IVUS-guided PCI. During a median 12-month follow-up, TVF occurred in 2.4% of AngioFFR-treated vessels and 1.9% of IVUS-treated vessels (P=0.50). TVF risk increased progressively with a higher composite lesion risk score (adjusted hazard ratio, 2.76 [95% CI, 1.35-5.65]). This association was more pronounced in the AngioFFR group (adjusted hazard ratio, 3.93 [95% CI, 1.79-8.63]) than in the IVUS group (adjusted hazard ratio, 1.62 [95% CI, 0.42-6.22]). Compared with IVUS guidance, AngioFFR-guided vessels with high-risk lesions (score >0.32) had a higher TVF rate (5.1% versus 1.9%; P=0.010), whereas outcomes were comparable in those with low-risk lesions (1.5% versus 1.9%; P=0.531). AngioFFR guidance was associated with lower target vessel PCI rates in low-risk lesions (60.1% versus 76.5%; P<0.001), whereas PCI rates were uniformly high and similar between groups in high-risk lesions (96.4% versus 97.4%; P=0.675).
Conclusions: A higher composite lesion risk score was associated with increased PCI rates and TVF risk after AngioFFR- or IVUS-guided treatment. AngioFFR guidance was associated with lower PCI rates in low-risk lesions, whereas IVUS guidance may yield more favorable outcomes in high-risk lesions.
背景：虽然血管造影衍生的分流储备（angiore）和血管内超声（IVUS）引导下的经皮冠状动脉介入治疗（PCI）产生相似的结果，但血管造影衍生的分流储备与较低的PCI率相关，但根据血管造影病变特征，血管造影衍生的分流储备与IVUS引导下的PCI的相对临床疗效尚不清楚。方法：这项对flavor II试验的事后分析纳入了狭窄≥50%的患者，随机分配到血管造影或ivus引导的PCI。综合病变风险评分采用基于边际Cox模型的线性预测因子，包括%直径狭窄、病变长度、真分叉、口病变和重度钙化。主要终点是靶血管衰竭（TVF：心源性死亡、靶血管心肌梗死和靶血管重建术）。结果：在1726例患者中，884例（51.2%）接受了angioffr引导的PCI， 842例（48.8%）接受了ivus引导的PCI。在中位12个月的随访期间，2.4%的angioffr治疗血管和1.9%的ivus治疗血管发生了TVF （P=0.50）。TVF风险随着复合病变风险评分的升高而逐渐增加（校正风险比[aHR] 2.76; 95% CI 1.35-5.65）。与IVUS组（aHR 1.62, 95% CI 0.42-6.22）相比，血管造影组（aHR 3.93, 95% CI 1.79-8.63）的相关性更为明显。与IVUS引导相比，angioffr引导的高危病变血管（评分>.32）的TVF率更高（5.1% vs 1.9%, P =0.010），而低危病变血管的结果相当（1.5% vs 1.9%, P =0.531）。在低危性病变中，血管造影指导与较低的靶血管PCI率相关（60.1% vs. 76.5%， P）。结论：较高的复合病变风险评分与血管造影指导或ivus引导治疗后PCI率和TVF风险增加相关。在低危病变中，血管造影指导与较低的PCI率相关，而IVUS指导在高危病变中可能产生更有利的结果。
期刊介绍：
Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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