FFR-Guided PCI Optimization Directed by High-Definition IVUS Versus Standard of Care The FFR REACT Trial

BACKGROUND Post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) <0.90 is common and has been related to impaired patient outcome. OBJECTIVES The authors sought to evaluate if PCI optimization directed by intravascular ultrasound (IVUS) in patients with post-PCI FFR <0.90 could improve 1-year target vessel failure (TVF) rates. METHODS In this single-center, randomized, double-blind trial, patients with a post-PCI FFR <0.90 at the time of angiographically successful PCI were randomized to IVUS-guided optimization or the standard of care (control arm). The primary endpoint was TVF (a composite of cardiac death, spontaneous target vessel myocardial infarction, and clinically driven target vessel revascularization) at 1 year. RESULTS A total of 291 patients with post-PCI FFR <0.90 were randomized (IVUS-guided optimization arm: n = 145/ 152 vessels, control arm: n = 146/157 vessels). The mean post-PCI FFR was 0.84 +/- 0.05. A total of 104 (68.4%) vessels in the IVUS-guided optimization arm underwent additional optimization including additional stenting (34.9%) or postdilatation only (33.6%), resulting in a mean increase in post-PCI FFR in these vessels from 0.82 +/- 0.06 to 0.85 +/- 0.05 (P < 0.001) and a post-PCI FFR $0.90 in 20% of the vessels. The 1-year TVF rate was comparable between the 2 study arms (IVUS-guided optimization arm: 4.2%, control arm: 4.8%; P = 0.79). There was a trend toward a lower incidence of clinically driven target vessel revascularization in the IVUS-guided optimization arm (0.7% vs. 4.2%, P = 0.06). CONCLUSIONS IVUS-guided post-PCI FFR optimization significantly improved post-PCI FFR. Because of lower-thanexpected event rates, post-PCI FFR optimization did not significantly lower TVF at the 1-year follow-up. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

Automated summary

This study aimed to evaluate the therapeutic effect of PCI optimization guided by intravascular ultrasound (IVUS) in patients with post-PCI FFR <0.90. The results showed that IVUS-guided optimization significantly improved post-PCI FFR, but did not significantly reduce TVF at the 1-year follow-up. There was a trend towards a lower incidence of clinically driven target vessel revascularization in the treatment group.