title: Clinical outcomes after intravascular ultrasound and fractional flow reserve assessment of intermediate coronary lesions. Propensity score matching of large cohorts from two institutions with a differential approach.
abstract: OBJECTIVE
  Assessment of intermediate coronary lesions can be done with fractional flow reserve (FFR) and intravascular ultrasound (IVUS). There are no randomised trials and only a small registry from one centre is available but this is subject to important bias. We sought to evaluate the clinical outcomes of an FFR strategy compared with an IVUS strategy for intermediate lesion assessment.
  
  
  RESULTS
  We compared the outcome of patients assessed with FFR and IVUS in two centres with a differential approach. After propensity score matching 400 pairs of patients were included. Revascularisation was done when FFR was <0.75 or minimum lumen area was <4 mm2 in vessels >3 mm, and <3.5 mm2 in vessels 2.5-3 mm, along with plaque burden >50%. After FFR and IVUS, 72% and 51.2% of lesions, respectively, were left untreated (p<0.001). At one and two years no significant differences in MACE-free survival were observed in overall groups (97.7% at one year and 93.1% at two years in the FFR group and 97.7% at one year and 95.6% at two years in the IVUS group; p=0.35) and among those with deferred intervention (97.9% at one year and 94.2% at two years in the FFR group and 96.5% at one year and 93.6% at two years in the IVUS group; p=0.7).
  
  
  CONCLUSIONS
  IVUS and FFR may be safely used to defer revascularisation of intermediate lesions. IVUS induces a higher degree of revascularisation but much lower than previously reported and does not affect the clinical outcome.
authors.affiliation: Unidad de Cardiologia Intervencionista, Cardiologia Valdecilla, Hospital Universitario Marques de Valdecilla, Santander, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: de la Torre Hernandez
authors.forename: Ramon
authors.initials: R
authors.lastname: Lopez-Palop
authors.forename: Tamara
authors.initials: T
authors.lastname: Garcia Camarero
authors.forename: Pilar
authors.initials: P
authors.lastname: Carrillo Saez
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Martin Gorria
authors.forename: Araceli
authors.initials: A
authors.lastname: Frutos Garcia
authors.forename: Blanca
authors.initials: B
authors.lastname: Arnaez Corada
authors.forename: Alberto
authors.initials: A
authors.lastname: Cordero Fort
authors.forename: Jenny M
authors.initials: JM
authors.lastname: Gomez Delgado
authors.forename: Pilar
authors.initials: P
authors.lastname: Agudo Quilez
authors.forename: Dae-Hyun
authors.initials: DH
authors.lastname: Lee
authors.forename: Irene Mateo
authors.initials: IM
authors.lastname: Rodriguez
authors.forename: Fermin
authors.initials: F
authors.lastname: Sainz Laso
authors.forename: Ahmed
authors.initials: A
authors.lastname: Khashaba
authors.forename: Sandra
authors.initials: S
authors.lastname: Miralles Arques
authors.forename: Javier
authors.initials: J
authors.lastname: Zueco Gil
mesh_terms: D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D057216:Propensity Score; D018084:Ultrasonography, Interventional