Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Discordance Between Angiographic Assessment and Fractional Flow Reserve or Intravascular Ultrasound in Intermediate Coronary Lesions: A Post-hoc Analysis of the FLAVOUR Trial

  • Jung-Hee Lee (Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Sung Gyun Ahn (Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Ho Sung Jeon (Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Jun-Won Lee (Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Young Jin Youn (Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Jinlong Zhang (Division of Cardiology, Department of Internal Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine) ;
  • Xinyang Hu (Division of Cardiology, Department of Internal Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine) ;
  • Jian'an Wang (Division of Cardiology, Department of Internal Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine) ;
  • Joo Myung Lee (Division of Cardiology, Department of Internal Medicine, Samsung Medical Center) ;
  • Joo-Yong Hahn (Division of Cardiology, Department of Internal Medicine, Samsung Medical Center) ;
  • Chang-Wook Nam (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Joon-Hyung Doh (Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital) ;
  • Bong-Ki Lee (Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital) ;
  • Weon Kim (Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital) ;
  • Jinyu Huang (Division of Cardiology, Department of Internal Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine) ;
  • Fan Jiang (Division of Cardiology, Department of Internal Medicine, Hangzhou Normal University Affiliated Hospital) ;
  • Hao Zhou (Division of Cardiology, Department of Internal Medicine, The 1st Affiliated Hospital of Wenzhou Medical University) ;
  • Peng Chen (Division of Cardiology, Department of Internal Medicine, The 2nd Affiliated Hospital of Wenzhou Medical University) ;
  • Lijiang Tang (Division of Cardiology, Department of Internal Medicine, Zhejiang Hospital) ;
  • Wenbing Jiang (Division of Cardiology, Department of Internal Medicine, The Third Clinical Institute Affiliated To Wenzhou Medical University) ;
  • Xiaomin Chen (Division of Cardiology, Department of Internal Medicine, Ningbo First Hospital) ;
  • Wenming He (Division of Cardiology, Department of Internal Medicine, The Affiliated Hospital of Medical School of Ningbo University) ;
  • Myeong-Ho Yoon (Division of Cardiology, Department of Internal Medicine, Ajou University Hospital) ;
  • Seung-Jea Tahk (Division of Cardiology, Department of Internal Medicine, Ajou University Hospital) ;
  • Ung Kim (Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center) ;
  • You-Jeong Ki (Division of Cardiology, Department of Internal Medicine, Uijeongbu Eulji Medical Center) ;
  • Eun-Seok Shin (Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Doyeon Hwang (Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital) ;
  • Jeehoon Kang (Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital) ;
  • Hyo-Soo Kim (Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital) ;
  • Bon-Kwon Koo (Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital)
  • Received : 2024.02.01
  • Accepted : 2024.05.20
  • Published : 2024.08.01
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Abstract

Background and Objectives: Angiographic assessment of coronary stenosis severity using quantitative coronary angiography (QCA) is often inconsistent with that based on fractional flow reserve (FFR) or intravascular ultrasound (IVUS). We investigated the incidence of discrepancies between QCA and FFR or IVUS, and the outcomes of FFR- and IVUS-guided strategies in discordant coronary lesions. Methods: This study was a post-hoc analysis of the FLAVOUR study. We used a QCA-derived diameter stenosis (DS) of 60% or greater, the highest tertile, to classify coronary lesions as concordant or discordant with FFR or IVUS criteria for percutaneous coronary intervention (PCI). The patient-oriented composite outcome (POCO) was defined as a composite of death, myocardial infarction, or revascularization at 24 months. Results: The discordance rate between QCA and FFR or IVUS was 30.2% (n=551). The QCA-FFR discordance rate was numerically lower than the QCA-IVUS discordance rate (28.2% vs. 32.4%, p=0.050). In 200 patients with ≥60% DS, PCI was deferred according to negative FFR (n=141) and negative IVUS (n=59) (15.3% vs. 6.5%, p<0.001). The POCO incidence was comparable between the FFR- and IVUS-guided deferral strategies (5.9% vs. 3.4%, p=0.479). Conversely, 351 patients with DS <60% underwent PCI according to positive FFR (n=118) and positive IVUS (n=233) (12.8% vs. 25.9%, p<0.001). FFR- and IVUS-guided PCI did not differ in the incidence of POCO (9.5% vs. 6.5%, p=0.294). Conclusions: The proportion of QCA-FFR or IVUS discordance was approximately one third for intermediate coronary lesions. FFR- or IVUS-guided strategies for these lesions were comparable with respect to POCO at 24 months.

Keywords

Acknowledgement

This study was investigator-initiated with grant support from Boston Scientific. The sponsors were not involved in protocol development or the study process, including site selection, management, data collection, or analysis of the results. This study was also supported by grants HI19C0481 and HC19C0305 from the Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health & Welfare, Republic of Korea.

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