Changes in post-PCI optimisation strategies with post-procedural FFR followed by IVUS

Suboptimal post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) values have been related to target vessel failure1. In the randomised FFR REACT trial, intravascular ultrasound (IVUS)-guided PCI optimisation in patients with a post-PCI FFR <0.90 significantly improved post-PCI FFR values2. The aim of this prespecified subanalysis was to assess the impact of post-PCI IVUS findings in addition to FFR pullback data on operator-defined optimisation strategies, assessed through a dedicated questionnaire.

The rationale and design of the FFR REACT trial have been published previously2. In brief, patients with an angiographically successful PCI and a post-PCI FFR <0.90 were randomised (1:1) to either IVUS-guided optimisation or no further treatment (the control arm). In the present subanalysis, only patients randomised to the IVUS-guided optimisation arm with complete IVUS imaging were included. The trial was approved by the local ethics committee, and all patients provided written informed consent.

Data on the optimisation strategy were routinely collected using a dedicated questionnaire directly after disclosure of the post-PCI FFR pullback data and before IVUS acquisition. To “would you perform additional treatment?”, the possible response options were 1)...