Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Dec 31;26(1):49-59.
doi: 10.1093/ehjci/jeae212.

Association of vessel fractional flow reserve (vFFR) with luminal obstruction and plaque characteristics as detected by optical coherence tomography (OCT) in patients with NSTE-ACS: the FAST OCT study

Annemieke C Ziedses des Plantes  1 , Alessandra Scoccia  1 , Frederik T W Groenland  1 , Maria N Tovar Forero  1 , Mariusz Tomaniak  2 , Janusz Kochman  2 , Wojciech Wojakowski  3 , Magda Roleder-Dylewska  3 , Koen Ameloot  4 , Tom Adriaenssens  5   6 , Wijnand K den Dekker  1 , Rutger-Jan Nuis  1 , Isabella Kardys  1 , Nicolas M Van Mieghem  1 , Ernest Spitzer  1   7 , Joost Daemen  1
Affiliations
Multicenter Study

Association of vessel fractional flow reserve (vFFR) with luminal obstruction and plaque characteristics as detected by optical coherence tomography (OCT) in patients with NSTE-ACS: the FAST OCT study

Annemieke C Ziedses des Plantes et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: There is a paucity of data on the performance of angiography-derived vessel fractional flow reserve (vFFR) in coronary artery lesions of patients presenting with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Optical coherence tomography (OCT) allows for visualization of lumen dimensions and plaque integrity with high resolution. The aim of this study was to define the association between vFFR and OCT findings in intermediate coronary artery lesions in patients presenting with NSTE-ACS.

Methods and results: The FAST OCT study was a prospective, multicenter, single-arm study. Patients presenting with NSTE-ACS with intermediate to severe coronary artery stenosis in one or multiple vessels with TIMI 3 flow suitable for OCT imaging were eligible. Complete pre-procedural vFFR and OCT data were available in 226 vessels (in 188 patients). A significant association between vFFR and minimal lumen area (MLA) was observed, showing an average decrease of 20.4% (95% CI -23.9% to -16.7%) in MLA per 0.10 decrease in vFFR (adjusted P < 0.001). vFFR ≤ 0.80 showed a sensitivity of 56.7% and specificity of 92.5% to detect MLA ≤ 2.5 mm2. Conversely, vFFR had a poor to moderate discriminative ability to detect plaque instability (sensitivity, 46.9%; specificity, 71.6%).

Conclusion: In patients with NSTE-ACS, vFFR is significantly associated with OCT-detected MLA, and vFFR ≤ 0.80 is highly predictive of the presence of significant disease based on OCT. Conversely, the sensitivity of vFFR ≤ 0.80 to detect OCT-assessed significant disease was low, indicating that the presence of significant OCT findings cannot be ruled out based on a negative vFFR.

Keywords: angiography-derived fractional flow reserve; non-ST-segment elevation acute coronary syndrome (NSTE-ACS); optical coherence tomography (OCT); vessel fractional flow reserve (vFFR).

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: Joost Daemen received institutional grant/research support from Abbott Vascular, Boston Scientific, ACIST Medical, Medtronic, Microport, Pie Medical, and ReCor medical and consultancy and speaker fees from Abbott Vascular, Abiomed, ACIST medical, Boston Scientific, Cardialysis BV, CardiacBooster, Kaminari Medical, ReCor Medical, PulseCath, Pie Medical, Sanofi, Siemens Health Care, and Medtronic. Nicolas van Mieghem received institutional research grant support from Abbott Vascular, Astra Zeneca, Biotronik, Boston Scientific, Medtronic, Edwards Lifesciences, Teleflex, PulseCath and Daiichi Sankyo and consultancy fees from Abbott, Boston Scientific, Medtronic, Abiomed, PulseCath BV, Daiichi Sankyo, Teleflex, Anteris, JenaValve, Amgen, Siemens, and Pie Medical. Rutger-Jan Nuis received research grant support from Vifor Pharma and Meril and consultancy fees from Edwards Lifesciences, Abbott, and Boston Scientific. Ernest Spitzer declares institutional contracts/grants for which he receives no direct compensation from Abbott, Biosensors Europe SA, Boston Scientific, Cardiawave, Edwards Lifesciences, Medtronic, Mixin Medtech (Suzhou) Co., Ltd., Shanghai Microport Medical Co., Ltd., NVT GmBH, Philips Healthcare, Pie Medical Imaging, Shanghai Shenqi Medical Technologies Co., Ltd., and Siemens Healthcare GmBH and declares being a board member of Cardialysis, European Cardiovascular Research Institute, EU-MDR Cardiovascular Collaboratory, and Academic Research Consortium. Wojciech Wojakowski received lecture fees from Abbott Vascular. Tom Adriaenssens reports speaker and consultancy fees from Abbott Vascular. Wojciech Wojakowski reports speaker fees from Abbott Vascular. The remaining authors report to have no disclosures.

Figures

Graphical Abstract
Graphical Abstract
MLA, minimal lumen area; vFFR, vessel fractional flow reserve; NSTE-ACS, non-ST-elevation acute coronary syndrome; DS, diameter stenosis; OCT, optical coherence tomography; AS, area stenosis.
Figure 1
Figure 1
Prevalence of OCT-assessed lesion characteristics in clear angiographic culprits, non-culprits, and ambiguous or unclear culprit lesions. Error bars represent 95% confidence intervals. All available OCT data (N = 236) are presented, regardless of availability of vFFR data. MLA, minimal lumen area; %AS, percentage area stenosis.
Figure 2
Figure 2
Scatterplots showing the relationship between vFFR, MLA, and OCT detected causes of luminal obstruction. *Treatment threshold: (1) %AS ≥ 75%; (2) MLA ≤ 2.5 mm² and %AS ≥ 50% or (3) plaque rupture and %AS ≥ 50%. %AS, percentage area stenosis; vFFR, vessel fractional flow reserve.
Figure 3
Figure 3
ROC curve of vFFR to predict OCT findings. *Treatment threshold: (1) %AS ≥ 75%; (2) %AS ≥ 50% and MLA ≤ 2.5 mm² or (3) %AS ≥ 50% and plaque rupture. MLA, minimal lumen area; %AS, percentage area stenosis; vFFR, vessel fractional flow reserve.
Figure 4
Figure 4
Diagnostic accuracy of vFFR with grey zone. MLA, minimal lumen area; %AS, percentage area stenosis; vFFR, vessel fractional flow reserve.
Figure 5
Figure 5
Prevalence of OCT-assessed lesion characteristics in culprit (A), non-culprit (B), and ambiguous or unclear culprits (C) with vFFR ≤ 0.80 vs. vFFR >0.80. Error bars represent 95% confidence intervals. MLA, minimal lumen area; %AS, percentage area stenosis; vFFR, vessel fractional flow reserve.
See this image and copyright information in PMC

Comment in

References

    1. Masdjedi K, Tanaka N, Van Belle E, Porouchani S, Linke A, Woitek FJ et al. Vessel fractional flow reserve (vFFR) for the assessment of stenosis severity: the FAST II study. EuroIntervention 2022;17:1498–505. - PMC - PubMed
    1. De Maria GL, Garcia-Garcia HM, Scarsini R, Hideo-Kajita A, Gonzalo López N, Leone AM et al. Novel indices of coronary physiology: do we need alternatives to fractional flow reserve? Circ Cardiovasc Interv 2020;13:e008487. - PubMed
    1. Liou KP, Ooi SM, Hoole SP, West NEJ. Fractional flow reserve in acute coronary syndrome: a meta-analysis and systematic review. Open Heart 2019;6:e000934. - PMC - PubMed
    1. Neumann F-J, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J 2018;40:87–165.
    1. Bogale N, Lempereur M, Sheikh I, Wood D, Saw J, Fung A. Optical coherence tomography (OCT) evaluation of intermediate coronary lesions in patients with NSTEMI. Cardiovasc Revasc Med 2016;17:113–8. - PubMed

Publication types

MeSH terms