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Observational Study
. 2022 Oct 24;15(20):2035-2048.
doi: 10.1016/j.jcin.2022.08.010. Epub 2022 Sep 28.

Optical Coherence Tomography Fractional Flow Reserve and Cardiovascular Outcomes in Patients With Acute Coronary Syndrome

Shunsuke Kakizaki  1 , Hiromasa Otake  2 , Fumiyasu Seike  3 , Hiroyuki Kawamori  1 , Takayoshi Toba  1 , Shinsuke Nakano  1 , Kosuke Tanimura  1 , Yu Takahashi  1 , Yusuke Fukuyama  1 , Daichi Fujimoto  1 , Koichi Nakamura  1 , Hiroyuki Fujii  1 , Amane Kozuki  4 , Junya Shite  4 , Masamichi Iwasaki  5 , Tomofumi Takaya  6 , Osamu Yamaguchi  3 , Ken-Ichi Hirata  1
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Free article
Observational Study

Optical Coherence Tomography Fractional Flow Reserve and Cardiovascular Outcomes in Patients With Acute Coronary Syndrome

Shunsuke Kakizaki et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: Optical coherence tomography-derived fractional flow reserve (OCT-FFR) correlates strongly with wire-based FFR; however, its clinical significance remains uncertain.

Objectives: This study sought to investigate the relationship between post-percutaneous coronary intervention (PCI) OCT-FFR and long-term clinical outcomes in acute coronary syndrome (ACS).

Methods: This retrospective, multicenter, observational cohort study included consecutive patients with ACS who underwent OCT-guided emergency PCI. We analyzed post-PCI OCT images and calculated OCT-FFR to identify independent factors associated with target vessel failure (TVF) after PCI.

Results: Among 364 enrolled patients, 54 experienced TVF during a median follow-up of 36 (IQR: 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 (HR per 0.1 increase: 0.38; 95% 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: Vessel-level OCT-FFR was an independent factor associated with TVF after PCI in patients with ACS. Adding the OCT-FFR measurement to post-PCI OCT findings may enable better discrimination of patients with subsequent TVF after PCI for ACS. (Relationship between Intracoronary Optical Coherence Tomography Derived Virtual Fractional Flow Reserve and cardiovascular outcome on Acute coronary syndrome; UMIN000043858).

Keywords: acute coronary syndrome; fractional flow reserve; optical coherence tomography; percutaneous coronary intervention; target vessel failure.

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Conflict of interest statement

Funding Support and Author Disclosures Drs Otake, Seike, Shite, Kozuki, and Takaya have received lecture honoraria from Abbott Vascular. Drs Seike, Yamaguchi, and Hirata have received grant support from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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