OCT-Fractional Flow Reserve and Clinical Outcomes in Patients With ACS

Oct 19, 2022
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Authors:
Kakizaki S, Otake H, Seike F, et al.
Citation:
Optical Coherence Tomography Fractional Flow Reserve and Cardiovascular Outcomes in Patients With Acute Coronary Syndrome. JACC Cardiovasc Interv 2022;15:2035-2048.
Summary By:
Debabrata Mukherjee, MD, FACC

Quick Takes

  • Despite angiographically satisfactory PCI results, post-PCI optical coherence tomography–derived fractional flow reserve (OCT-FFR) showed a wide variation in patients with ACS who underwent OCT-guided PCI.
  • Low vessel-level OCT-FFR was independently associated with target vessel failure (TVF) after PCI in patients with ACS, demonstrating the incremental value of vessel-level OCT-FFR in identifying patients with subsequent TVF beyond morphological OCT findings.
  • There is a need for larger prospective study to further evaluate and validate the clinical impact of measuring OCT-FFR in the setting of ACS.

Study Questions:

What is the relationship between post–percutaneous coronary intervention (PCI) optical coherence tomography–derived fractional flow reserve (OCT-FFR) and long-term clinical outcomes in acute coronary syndrome (ACS)?

Methods:

The investigators conducted a retrospective, multicenter, observational cohort study and included consecutive patients with ACS who underwent OCT-guided emergency PCI. They analyzed post-PCI OCT images and calculated OCT-FFR to identify independent factors associated with target vessel failure (TVF) after PCI. The primary outcome of the study was TVF, which is a composite of cardiac death, target vessel–related myocardial infarction, and ischemia-driven target vessel revascularization (TVR). The time to clinical outcomes was assessed by Kaplan-Meier analyses, and the log-rank test was performed to compare groups. Cox regression analysis was used to identify independent factors associated with TVF, TLR, and non-TLR TVR, and logistic regression analysis was performed to identify independent factors associated with low vessel-level OCT-FFR.

Results:

Among 364 enrolled patients, 54 experienced TVF during a median follow-up of 36 (interquartile range 26-48) months. Vessel-level OCT-FFR was significantly lower in the TVF group than in the non-TVF group (0.87 vs. 0.94; p < 0.001). In the multivariable Cox regression analysis, low vessel-level OCT-FFR (hazard ratio [HR] per 0.1 increase, 0.38; 95% confidence interval [CI], 0.29-0.49; p < 0.001) and thin-cap fibroatheroma in the nonculprit lesion were independently associated with TVF. The TVF rate of vessels with both low vessel-level OCT-FFR (<0.90) and thin-cap fibroatheroma in the nonculprit lesion was 8.1 times higher than that of all other vessels (69.3% vs. 12.4%; HR, 8.13; 95% CI, 4.33-15.25; log-rank p < 0.001). Furthermore, adding vessel-level OCT-FFR to baseline characteristics and post-PCI OCT findings improved discriminatory and reclassification ability in identifying patients with subsequent TVF.

Conclusions:

The authors concluded that vessel-level OCT-FFR was an independent factor associated with TVF after PCI in patients with ACS.

Perspective:

This cohort study reports that despite angiographically satisfactory PCI results, post-PCI OCT-FFR showed a wide variation in patients with ACS who underwent OCT-guided PCI. In addition to patient characteristics and post-OCT findings, low vessel-level OCT-FFR was independently associated with TVF after PCI in patients with ACS, demonstrating the incremental value of vessel-level OCT-FFR in identifying patients with subsequent TVF beyond morphological OCT findings. Of note, the TVF rate of vessels with both low vessel-level OCT-FFR and thin-cap fibroatheroma in the nonculprit lesion was 8.1 times higher than that of all other vessels. There is a need for larger prospective study to further evaluate and validate the clinical impact of measuring OCT-FFR in the setting of ACS.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Angiography, Diagnostic Imaging, Fractional Flow Reserve, Myocardial, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Percutaneous Coronary Intervention, Plaque, Atherosclerotic, Secondary Prevention, Tomography, Optical Coherence


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