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, 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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