Optical coherence tomography compared with fractional flow reserve guided approach in acute coronary syndromes

A propensity matched analysis

Fabrizio D'Ascenzo, Mario Iannaccone, Ovidio De Filippo, Antonio Maria Leone, Giampaolo Niccoli, Filippo Zilio, Fabrizio Ugo, Enrico Cerrato, Massimo Fineschi, Massimo Mancone, Stefano Rigattieri, Nicolas Amabile, Marco Ferlini, Gennaro Sardella, Alberto Cresti, Umberto Barbero, Pascal Motreff, Francesco Colombo, Salvatore Colangelo, Roberto Garbo & 10 others Giuseppe Biondi-Zoccai, Corrado Tamburino, Antonio Montefusco, Pierlugi Omedè, Claudio Moretti, Maurizio D'amico, Geraud Souteyrand, Fiorenzo Gaita, Ugo Limbruno, Andrea Picchi

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Aim To compare in patients with ACS (acute coronary syndromes) a PCI (percutaneous coronary intervention) approach based on FFR (fractional flow reserve) vs. one based on OCT (optical coherence tomography). Methods and results Consecutive patients admitted for ACS and treated with a PCI approach based on OCT or on FFR (recruited in two different studies) were compared and matched with propensity score analysis. Target Lesion revascularization (TLR) was the primary end point, while major adverse cardiovascular events [MACEs defined as the composite of death from cardiac causes, non-fatal MI, clinically driven target vessel revascularization (TVR), or re-hospitalization due to unstable angina] were the secondary ones. Sub-group analysis was performed for patients with FFR/OCT performed on culprit lesions and not. 285 patients were enrolled in the OCT-guided group and 335 in the FFR-guided group, 197 for each being selected after propensity score. After 25 months (range: 7–39 months), OCT-guided group were exposed to lower incidence of TLR (4.1% vs. 14.2% p < 0.01) compared with FFR-guided group without impact on MACEs (14.2% vs. 14.2%, p = 1) or all-cause death (3.6% vs. 1.1%, p = 0.34). At Kaplan-Maier curve analysis for MACEs OCT-guided and FFR-guided groups showed similar outcomes (HR 1.19, CI 0.65–2.2, p = 0.54). Subgroup analysis on culprit and not culprit vessel demonstrated consistent results. Conclusions An OCT based approach in ACS patients offers a reduction in TLR when compared to a PCI-FFR driven. These findings should be confirmed in randomized controlled trial.

Original languageEnglish
Pages (from-to)54-58
Number of pages5
JournalInternational Journal of Cardiology
Volume244
DOIs
Publication statusPublished - Oct 1 2017

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Optical Coherence Tomography
Acute Coronary Syndrome
Percutaneous Coronary Intervention
Propensity Score
Cause of Death
Unstable Angina
Hospitalization
Randomized Controlled Trials
Incidence

Keywords

  • Acute coronary syndrome
  • Drug eluting stent
  • Fractional flow reserve
  • Optical coherence tomography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Optical coherence tomography compared with fractional flow reserve guided approach in acute coronary syndromes : A propensity matched analysis. / D'Ascenzo, Fabrizio; Iannaccone, Mario; De Filippo, Ovidio; Leone, Antonio Maria; Niccoli, Giampaolo; Zilio, Filippo; Ugo, Fabrizio; Cerrato, Enrico; Fineschi, Massimo; Mancone, Massimo; Rigattieri, Stefano; Amabile, Nicolas; Ferlini, Marco; Sardella, Gennaro; Cresti, Alberto; Barbero, Umberto; Motreff, Pascal; Colombo, Francesco; Colangelo, Salvatore; Garbo, Roberto; Biondi-Zoccai, Giuseppe; Tamburino, Corrado; Montefusco, Antonio; Omedè, Pierlugi; Moretti, Claudio; D'amico, Maurizio; Souteyrand, Geraud; Gaita, Fiorenzo; Limbruno, Ugo; Picchi, Andrea.

In: International Journal of Cardiology, Vol. 244, 01.10.2017, p. 54-58.

Research output: Contribution to journalArticle

D'Ascenzo, F, Iannaccone, M, De Filippo, O, Leone, AM, Niccoli, G, Zilio, F, Ugo, F, Cerrato, E, Fineschi, M, Mancone, M, Rigattieri, S, Amabile, N, Ferlini, M, Sardella, G, Cresti, A, Barbero, U, Motreff, P, Colombo, F, Colangelo, S, Garbo, R, Biondi-Zoccai, G, Tamburino, C, Montefusco, A, Omedè, P, Moretti, C, D'amico, M, Souteyrand, G, Gaita, F, Limbruno, U & Picchi, A 2017, 'Optical coherence tomography compared with fractional flow reserve guided approach in acute coronary syndromes: A propensity matched analysis', International Journal of Cardiology, vol. 244, pp. 54-58. https://doi.org/10.1016/j.ijcard.2017.05.108
D'Ascenzo, Fabrizio ; Iannaccone, Mario ; De Filippo, Ovidio ; Leone, Antonio Maria ; Niccoli, Giampaolo ; Zilio, Filippo ; Ugo, Fabrizio ; Cerrato, Enrico ; Fineschi, Massimo ; Mancone, Massimo ; Rigattieri, Stefano ; Amabile, Nicolas ; Ferlini, Marco ; Sardella, Gennaro ; Cresti, Alberto ; Barbero, Umberto ; Motreff, Pascal ; Colombo, Francesco ; Colangelo, Salvatore ; Garbo, Roberto ; Biondi-Zoccai, Giuseppe ; Tamburino, Corrado ; Montefusco, Antonio ; Omedè, Pierlugi ; Moretti, Claudio ; D'amico, Maurizio ; Souteyrand, Geraud ; Gaita, Fiorenzo ; Limbruno, Ugo ; Picchi, Andrea. / Optical coherence tomography compared with fractional flow reserve guided approach in acute coronary syndromes : A propensity matched analysis. In: International Journal of Cardiology. 2017 ; Vol. 244. pp. 54-58.
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abstract = "Aim To compare in patients with ACS (acute coronary syndromes) a PCI (percutaneous coronary intervention) approach based on FFR (fractional flow reserve) vs. one based on OCT (optical coherence tomography). Methods and results Consecutive patients admitted for ACS and treated with a PCI approach based on OCT or on FFR (recruited in two different studies) were compared and matched with propensity score analysis. Target Lesion revascularization (TLR) was the primary end point, while major adverse cardiovascular events [MACEs defined as the composite of death from cardiac causes, non-fatal MI, clinically driven target vessel revascularization (TVR), or re-hospitalization due to unstable angina] were the secondary ones. Sub-group analysis was performed for patients with FFR/OCT performed on culprit lesions and not. 285 patients were enrolled in the OCT-guided group and 335 in the FFR-guided group, 197 for each being selected after propensity score. After 25 months (range: 7–39 months), OCT-guided group were exposed to lower incidence of TLR (4.1{\%} vs. 14.2{\%} p < 0.01) compared with FFR-guided group without impact on MACEs (14.2{\%} vs. 14.2{\%}, p = 1) or all-cause death (3.6{\%} vs. 1.1{\%}, p = 0.34). At Kaplan-Maier curve analysis for MACEs OCT-guided and FFR-guided groups showed similar outcomes (HR 1.19, CI 0.65–2.2, p = 0.54). Subgroup analysis on culprit and not culprit vessel demonstrated consistent results. Conclusions An OCT based approach in ACS patients offers a reduction in TLR when compared to a PCI-FFR driven. These findings should be confirmed in randomized controlled trial.",
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T1 - Optical coherence tomography compared with fractional flow reserve guided approach in acute coronary syndromes

T2 - A propensity matched analysis

AU - D'Ascenzo, Fabrizio

AU - Iannaccone, Mario

AU - De Filippo, Ovidio

AU - Leone, Antonio Maria

AU - Niccoli, Giampaolo

AU - Zilio, Filippo

AU - Ugo, Fabrizio

AU - Cerrato, Enrico

AU - Fineschi, Massimo

AU - Mancone, Massimo

AU - Rigattieri, Stefano

AU - Amabile, Nicolas

AU - Ferlini, Marco

AU - Sardella, Gennaro

AU - Cresti, Alberto

AU - Barbero, Umberto

AU - Motreff, Pascal

AU - Colombo, Francesco

AU - Colangelo, Salvatore

AU - Garbo, Roberto

AU - Biondi-Zoccai, Giuseppe

AU - Tamburino, Corrado

AU - Montefusco, Antonio

AU - Omedè, Pierlugi

AU - Moretti, Claudio

AU - D'amico, Maurizio

AU - Souteyrand, Geraud

AU - Gaita, Fiorenzo

AU - Limbruno, Ugo

AU - Picchi, Andrea

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Aim To compare in patients with ACS (acute coronary syndromes) a PCI (percutaneous coronary intervention) approach based on FFR (fractional flow reserve) vs. one based on OCT (optical coherence tomography). Methods and results Consecutive patients admitted for ACS and treated with a PCI approach based on OCT or on FFR (recruited in two different studies) were compared and matched with propensity score analysis. Target Lesion revascularization (TLR) was the primary end point, while major adverse cardiovascular events [MACEs defined as the composite of death from cardiac causes, non-fatal MI, clinically driven target vessel revascularization (TVR), or re-hospitalization due to unstable angina] were the secondary ones. Sub-group analysis was performed for patients with FFR/OCT performed on culprit lesions and not. 285 patients were enrolled in the OCT-guided group and 335 in the FFR-guided group, 197 for each being selected after propensity score. After 25 months (range: 7–39 months), OCT-guided group were exposed to lower incidence of TLR (4.1% vs. 14.2% p < 0.01) compared with FFR-guided group without impact on MACEs (14.2% vs. 14.2%, p = 1) or all-cause death (3.6% vs. 1.1%, p = 0.34). At Kaplan-Maier curve analysis for MACEs OCT-guided and FFR-guided groups showed similar outcomes (HR 1.19, CI 0.65–2.2, p = 0.54). Subgroup analysis on culprit and not culprit vessel demonstrated consistent results. Conclusions An OCT based approach in ACS patients offers a reduction in TLR when compared to a PCI-FFR driven. These findings should be confirmed in randomized controlled trial.

AB - Aim To compare in patients with ACS (acute coronary syndromes) a PCI (percutaneous coronary intervention) approach based on FFR (fractional flow reserve) vs. one based on OCT (optical coherence tomography). Methods and results Consecutive patients admitted for ACS and treated with a PCI approach based on OCT or on FFR (recruited in two different studies) were compared and matched with propensity score analysis. Target Lesion revascularization (TLR) was the primary end point, while major adverse cardiovascular events [MACEs defined as the composite of death from cardiac causes, non-fatal MI, clinically driven target vessel revascularization (TVR), or re-hospitalization due to unstable angina] were the secondary ones. Sub-group analysis was performed for patients with FFR/OCT performed on culprit lesions and not. 285 patients were enrolled in the OCT-guided group and 335 in the FFR-guided group, 197 for each being selected after propensity score. After 25 months (range: 7–39 months), OCT-guided group were exposed to lower incidence of TLR (4.1% vs. 14.2% p < 0.01) compared with FFR-guided group without impact on MACEs (14.2% vs. 14.2%, p = 1) or all-cause death (3.6% vs. 1.1%, p = 0.34). At Kaplan-Maier curve analysis for MACEs OCT-guided and FFR-guided groups showed similar outcomes (HR 1.19, CI 0.65–2.2, p = 0.54). Subgroup analysis on culprit and not culprit vessel demonstrated consistent results. Conclusions An OCT based approach in ACS patients offers a reduction in TLR when compared to a PCI-FFR driven. These findings should be confirmed in randomized controlled trial.

KW - Acute coronary syndrome

KW - Drug eluting stent

KW - Fractional flow reserve

KW - Optical coherence tomography

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