Journal Article

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

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

2025

Overview

IntroductionAn evidence-based selection between fractional flow reserve (FFR) and optical coherence tomography (OCT) to drive percutaneous coronary intervention is still lacking.MethodsPatients 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.Results405 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).ConclusionsCompared 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.

• Publisher: British Cardiovascular Society,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Acute Coronary Syndrome / Acute coronary syndromes / Age / Aged / Angina pectoris / Angioplasty / Cardiac Catheterization / Cardiovascular disease / Clinical Decision-Making / Coronary Angiography / Coronary Artery Disease - diagnosis / Coronary Artery Disease - diagnostic imaging / Coronary Artery Disease - mortality / Coronary Artery Disease - physiopathology / Coronary Artery Disease - surgery / Coronary Stenosis - diagnosis / Coronary Stenosis - diagnostic imaging / Coronary Stenosis - mortality / Coronary Stenosis - physiopathology / Coronary Stenosis - surgery / Coronary vessels / Coronary Vessels - diagnostic imaging / Coronary Vessels - physiopathology / Coronary Vessels - surgery / Datasets / Diabetes / Ejection fraction / Female / Fractional Flow Reserve, Myocardial - physiology / Heart attacks / Humans / Hypertension / Interventional Cardiology / Male / Medical imaging / Medical prognosis / Metabolic disorders / Middle Aged / Original Research / Patients / Percutaneous Coronary Intervention / Percutaneous Coronary Intervention - adverse effects / Percutaneous Coronary Intervention - methods / Predictive Value of Tests / Registries / Risk Factors / Tomography / Tomography, Optical Coherence - methods / Treatment Outcome / Variables / Vein & artery diseases