Two PCI Guidance Systems on Par for Intermediate Coronary Stenosis
For stenting choices in intermediate coronary stenosis, fractional float reserve (FFR) steering led to outcomes that possess been much like these with intravascular ultrasound (IVUS) steering, however with extra procedures safely deferred, the FLAVOUR trial confirmed.
FFR-guided percutaneous coronary intervention (PCI) led to a noninferior rate for the composite necessary endpoint of all-trigger mortality, myocardial infarction, or any revascularization at 2 years when in contrast with IVUS-guided PCI (8.1% vs 8.5%, P=0.015 for noninferiority), reported Bon-Kwon Koo, MD, PhD, of Seoul National College Scientific institution in South Korea.
Every particular person ingredient likewise came out identical, as did stroke and cardiac dying, he famed at the American College of Cardiology (ACC) meeting in Washington, D.C.
Nevertheless, most effective 44.4% of patients within the FFR steering crew underwent PCI, when in contrast with 65.3% of patients within the IVUS steering crew.
“In actuality gleaming. I mediate here is going to lead how we device patients within the lab,” mentioned ACC Interventional Council chair Frederick Welt, MD, of the College of Utah in Salt Lake City, who served as the discussant for the trial at an ACC press convention.
Whereas there hadn’t been a host of details readily available for comparison, the identical outcomes with much less stenting within the FFR crew “confirms the formulation a host of us feel referring to the 2 applied sciences … that FFR must tranquil be used to resolve who must tranquil earn an intervention after which IVUS be used to optimize the intervention,” he famed.
Roxana Mehran, MD, of Mount Sinai College of Treatment in Contemporary York City, agreed.
“We wanted a particular perceive for FFR after FAME 3,” she mentioned one day of the click convention. “We’re having the actual identical scientific outcomes however noteworthy [fewer] patients needing to endure stent implantation with FFR steering. … It be with out a doubt telling me that’s the formulation to begin, not not up to for steering.”
“The textbook-indulge in answer could more than in all probability be begin with physiology, and whenever you happen to deserve to entire PCI, imaging-guided PCI must tranquil be performed,” Koo mentioned. “But from a gleaming point of note, it be not straightforward to order both. … In the intermediate stenosis setting, whenever you happen to deserve to capture one, you would higher capture physiology. But the splendid could more than in all probability be the utilization of imaging and physiology.”
The trial incorporated 1,682 patients at 18 centers in China and Korea with suspected ischemic heart illness and intermediate coronary stenosis on coronary angiography, with a de novo target vessel that will in all probability be of a size eligible for PCI. Indicate age among patients became 65, and 70.6% possess been males.
Outcomes possess been identical among these chosen for medical cure and in PCI-handled patients in both groups.
Given how effectively the medically handled FFR crew did, with tournament rates even numerically lower than these within the IVUS-guided crew (5.0% vs 5.9%), “it again tells me that deferring the lesion thru FFR steering is intensely safe, [and] associated to very low occasions,” Mehran mentioned.
Whereas the trial did not explore particularly at FFR for stent optimization after placement, noteworthy extra details is necessary on the type of device. “Don’t streak away the lab with out incandescent it’s good to more than in all probability more than in all probability also very effectively be optimized,” Mehran added.
Nevertheless, Welt famed that about 30% of the trial participants had acute coronary syndrome. “There is a little bit bit of discomfort within the interventional community referring to the utilization of FFR in [ACS] patients,” he mentioned, adding that subgroup analyses will in all probability be welcome.
This trial became supported by study grants from Boston Scientific.