Angiography-Derived FFR Versus IVUS to Guide PCI According to Angiographic Lesion Characteristics
Year: 2026
Type: article
Abstract: BACKGROUND: While angiography-derived fractional flow reserve (AngioFFR)- and intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) yield similar outcomes, with AngioFFR associated with lower PCI rates, the relative clinical effectiveness of AngioFFR versus IVUS-guided PCI according to angiographic lesion characteristics remains unclear. METHODS: This post hoc analysis of the FLAVOUR II trial (Comparison of Angiography-Derived Fractional Flow Reserve- and Intravascular Ultrasound-Guided Intervention Strategy for Clinical Outcomes in Patients with Coronary Artery Disease) included patients with ≥50% stenosis randomized to AngioFFR- or IVUS-guided PCI. A composite lesion risk score was derived using a marginal Cox model-based linear predictor incorporating % diameter stenosis, lesion length, true bifurcation, ostial lesion, and heavy calcification. The primary end point was target vessel failure (TVF: cardiac death, target vessel myocardial infarction, and target vessel revascularization). RESULTS: Among 1726 patients, 884 (51.2%) underwent AngioFFR-guided PCI and 842 (48.8%) underwent IVUS-guided PCI. During a median 12-month follow-up, TVF occurred in 2.4% of AngioFFR-treated vessels and 1.9% of IVUS-treated vessels ( P =0.50). TVF risk increased progressively with a higher composite lesion risk score (adjusted hazard ratio, 2.76 [95% CI, 1.35–5.65]). This association was more pronounced in the AngioFFR group (adjusted hazard ratio, 3.93 [95% CI, 1.79–8.63]) than in the IVUS group (adjusted hazard ratio, 1.62 [95% CI, 0.42–6.22]). Compared with IVUS guidance, AngioFFR-guided vessels with high-risk lesions (score >0.32) had a higher TVF rate (5.1% versus 1.9%; P =0.010), whereas outcomes were comparable in those with low-risk lesions (1.5% versus 1.9%; P =0.531). AngioFFR guidance was associated with lower target vessel PCI rates in low-risk lesions (60.1% versus 76.5%; P <0.001), whereas PCI rates were uniformly high and similar between groups in high-risk lesions (96.4% versus 97.4%; P =0.675). CONCLUSIONS: A higher composite lesion risk score was associated with increased PCI rates and TVF risk after AngioFFR- or IVUS-guided treatment. AngioFFR guidance was associated with lower PCI rates in low-risk lesions, whereas IVUS guidance may yield more favorable outcomes in high-risk lesions. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04397211.
Authors: Seokhun Yang, Xinyang Hu, Jinlong Zhang, Jin-Eun Song, Jun Jiang, Xiaoping Peng, Dongsheng Lu, Yibin Pan, Lijun Guo, Jilin Li, Wenming He, Hao Zhou, Jun Pu, Jinyu Huang, Fan Jiang, Qiang Liu, Daqing Song, Liang Lu, Zhenfeng Cheng, Bin Yang, Jianliang Ma, Peng Chen, Shiqiang Li, Zhaohui Meng, Lijiang Tang, Yongzhen Fan, Eun-Seok Shin, Shenxian Tu, Chang-Wook Nam, William F. Fearon, Jian’an Wang, Bon-Kwon Koo, the FLAVOUR II Study Group
Institutions: Seoul National University Hospital, Second Affiliated Hospital of Zhejiang University, Zhejiang University, First Affiliated Hospital of Nanchang University, Jinhua Central Hospital, Peking University Third Hospital, Second Affiliated Hospital of Shantou University Medical College, Ningbo University, First Affiliated Hospital of Wenzhou Medical University, Shanghai Jiao Tong University, Renji Hospital, Affiliated Hangzhou First People's Hospital, Westlake University, School of Medicine, Affiliated Hospital of Hangzhou Normal University, Fourth People’s Hospital of Jinan, Jining First People's Hospital, Dongyang People's Hospital, Huzhou Central Hospital, Shanxi Medical University, Second Hospital of Shanxi Medical University, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Wenzhou Medical University, Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Kunming Medical University, First Affiliated Hospital of Kunming Medical University, Zhejiang Hospital, Zhongnan Hospital of Wuhan University, University of Ulsan, Ulsan University Hospital, Keimyung University Dongsan Medical Center, Keimyung University Dongsan Hospital, VA Palo Alto Health Care System, Stanford Medicine, Stanford Cardiovascular Institute, Stanford University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7161642255