Fractional Flow Reserve or Intravascular Ultrasonography to Guide PCI

作者：Bon‐Kwon Koo, Xinyang Hu, Jeehoon Kang, Jinlong Zhang, Jun Jiang, Joo‐Yong Hahn, Chang‐Wook Nam, Joon‐Hyung Doh, Bong‐Ki Lee, Weon Kim, Jinyu Huang, Fan Jiang, Hao Zhou, Peng Chen, Lijiang Tang, Wenbing Jiang, Xiaomin Chen, Wenming He, Sung Gyun Ahn, Myeong‐Ho Yoon, Ung Kim, Joo Myung Lee, Doyeon Hwang, You‐Jeong Ki, Eun‐Seok Shin, Hyo‐Soo Kim, Seung‐Jea Tahk, Jianan Wang · 发表于：New England Journal of Medicine · 年份：2022 · DOI：10.1056/nejmoa2201546 · 被引用次数：157 · 研究领域：Coronary Interventions and Diagnostics、Cardiac Imaging and Diagnostics、Cerebrovascular and Carotid Artery Diseases

BACKGROUNDIn patients with coronary artery disease who are being evaluated for percutaneous coronary intervention (PCI), procedures can be guided by fractional flow reserve (FFR) or intravascular ultrasonography (IVUS) for decision making regarding revascularization and stent implantation.However, the differences in clinical outcomes when only one method is used for both purposes are unclear. METHODSWe randomly assigned 1682 patients who were being evaluated for PCI for the treatment of intermediate stenosis (40 to 70% occlusion by visual estimation on coronary angiography) in a 1:1 ratio to undergo either an FFR-guided or IVUSguided procedure.FFR or IVUS was to be used to determine whether to perform PCI and to assess PCI success.In the FFR group, PCI was to be performed if the FFR was 0.80 or less.In the IVUS group, the criteria for PCI were a minimal lumen area measuring either 3 mm 2 or less or measuring 3 to 4 mm 2 with a plaque burden of more than 70%.The primary outcome was a composite of death, myocardial infarction, or revascularization at 24 months after randomization.We tested the noninferiority of the FFR group as compared with the IVUS group (noninferiority margin, 2.5 percentage points). RESULTSThe frequency of PCI was 44.4% among patients in the FFR group and 65.3% among those in the IVUS group.At 24 months, a primary-outcome event had occurred in 8.1% of the patients in the FFR group and in 8.5% of those in the IVUS group (absolute difference, -0.4 percentage ...