Original Research

DOI: 10.4244/EIJ-D-24-00589

Fractional flow reserve- and intravascular ultrasound-guided strategies for intermediate coronary stenosis and low lesion complexity in patients with or without diabetes: a post hoc analysis of the randomised FLAVOUR trial

Sung Woo Cho1, MD, PhD; Jeehoon Kang2, MD; Jinlong Zhang3, MD, PhD; Xinyang Hu3, MD, PhD; Ji-won Hwang1, MD, PhD; Jae-Jin Kwak1, MD, PhD; Joo-Yong Hahn4, MD, PhD; Chang-Wook Nam5, MD, PhD; Bong-Ki Lee6, MD; Weon Kim7, MD; Jinyu Huang8, MD; Fan Jiang9, MD; Hao Zhou10, MD; Peng Chen11, MD; Lijiang Tang12, MD; Wenbing Jiang13, MD; Xiaomin Chen14, MD; Wenming He15, MD; Sung Gyun Ahn16, MD; Myeong-Ho Yoon17, MD; Ung Kim18, MD; Joo Myung Lee4, MD, PhD; Doyeon Hwang2, MD; You-Jeong Ki19, MD, PhD; Eun-Seok Shin20, MD, PhD; Hyo-Soo Kim1, MD, PhD; Seung-Jea Tahk17, MD, PhD; Jian’an Wang3, MD, PhD; Bon-Kwon Koo2, MD, PhD; Joon-Hyung Doh1, MD, PhD

Abstract

Background: A recent randomised trial demonstrated fractional flow reserve (FFR) guidance for percutaneous coronary intervention (PCI) was non-inferior to intravascular ultrasound (IVUS) guidance regarding clinical outcomes, with a lower frequency of PCI.

Aims: We sought to evaluate the prognosis of FFR versus IVUS guidance for PCI of intermediate coronary artery stenosis and low lesion complexity in diabetic and non-diabetic patients.

Methods: This study is a prespecified post hoc analysis from the FLAVOUR trial. The primary outcome was major adverse cardiac events (MACE) at 24 months, defined as a composite of death, myocardial infarction or any revascularisation. The secondary outcomes were target vessel failure (TVF) and each component of MACE and TVF at 24 months.

Results: Among 1,682 randomly assigned patients, 554 (32.9%) had diabetes, and the mean SYNTAX score was 8.64±6.03 at baseline. The FFR group had a lower PCI rate than the IVUS group in both diabetic (48.2% vs 69.1%; p<0.001) and non-diabetic (42.6% vs 63.3%; p<0.001) patients. At 24 months, there was no difference in the cumulative incidence of MACE between the FFR and the IVUS groups in either diabetic (9.3% vs 8.3%; p=0.90) or non-diabetic (7.5% vs 8.6%; p=0.50) patients. The cumulative incidence of TVF was also comparable between the FFR and the IVUS groups regardless of diabetic status.

Conclusions: In patients with intermediate coronary stenosis and low lesion complexity, regardless of diabetic status, FFR guidance had no significant differences in MACE or TVF with a lower frequency of PCI compared with IVUS guidance.

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Volume 21 Number 3
Feb 3, 2025
Volume 21 Number 3
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