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The Potential Safety of Deferring Percutaneous Coronary Intervention Based on Fractional Flow Reserve in The Ischemia-Induced Intermediate Lesions Defined by Intravascular Ultrasound

Jiang-Li Han, Ke Cao, Yong-Zhen Zhang, Ming Cui, Jie Niu, Gui-Song Wang, Fu-Chun Zhang, Lin Mi, Dan Zhu, Li-Jun Guo* and Wei Gao

It has been proved that it could achieve optimal clinical outcomes by using fractional flow reserve (FFR) to guide percutaneous coronary intervention (PCI). Many studies have reported some anatomic measurements such as minimal lumen area (MLA) by intravascular ultrasound (IVUS) is associated with FFR, but there were few data in Chinese. We assessed the optimal IVUS criteria for functional significant stenosis in Chinese and then evaluated the potential safety of deferring PCI according to FFR>0.80 in those IVUS defined ischemic lesions. A total of 125 intermediate lesions (30% to 70% diameter stenosis) from 101 patients were evaluated by both FFR and IVUS, and a 12 months follow up was made. The major adverse cardiac event (MACE) was defined as a combined endpoint of all cause death, non-fatal myocardial infarction (MI) and target vessel revascularization (TVR). IVUS-MLA showed a positive correlation with FFR (r=0.483, p<0.001) and was one of the independent predictor of FFR ≤ 0.80. The best cutoff value of MLA to define the functional significance was 3.25 mm2 (AUC=0.744, 95%CI=0.651-0.839, sensitivity 72.2%, specificity 66.3%). In the retrospective subgroup analysis, there were 56 lesions from 50 patients with IVUSMLA ≤ 3.25 mm2, and 26 lesions with FFR ≤ 0.80 received PCI. After review the data of 12-month follow-up, we found that there was no difference in MACE rate between 2 groups (8.3% in PCI group vs. 0.0% in deferring PCI group, p=0.225). The total events rate (MACE and angina pectoris) was also similar in 2 groups (41.6% in PCI groups vs. 23.1% deferring PCI group, p=0.159). This study indicated significant correlation between FFR and IVUS-MLA in coronary intermediate lesions. Though 3.25 mm2 was the best MLA cut-off value to predict FFR ≤ 0.80 in Chinese, the positive predict value was still low. As a result, deferring PCI based on FFR in those MLA ≤ 3.25 mm2 lesions was potentially safe during 12-month follow-up.