Comparative efficacy of intravascular ultrasound and fractional flow reserve in guiding percutaneous coronary intervention

This study aimed to compare the postoperative function of patients with critical coronary artery lesions undergoing intervention guided by intravascular ultrasound (IVUS) vs those guided by fractional flow reserve (FFR). A total of 226 patients (293 lesions) with coronary angiography-confirmed stenosis of 40% to 70% were enrolled and divided into 3 groups: the IVUS-guided group (98 lesions), the FFR-guided group (101 lesions), and the medical treatment group (94 lesions). In the IVUS-guided group, coronary stent implantation was performed if the minimum lumen area at the stenosis was < 4 mm2. In the FFR-guided group, intervention was performed if FFR < 0.8. Patients were followed for 1-year postoperatively, and the incidence of major adverse cardiovascular events (MACE), including death, myocardial infarction, and target vessel revascularization, was compared among the 3 groups. There were no significant differences in the degree of stenosis or lesion length among the 3 groups as determined by coronary angiography. The proportion of patients undergoing coronary intervention was significantly higher in the IVUS-guided group compared to the FFR-guided group (P < .001). However, there was no significant difference in the incidence of MACE among the 3 groups (P = .182). This study found no significant difference in MACE between the 3 guidance strategies - IVUS, FFR, and angiography - in patients with intermediate coronary lesions undergoing PCI. These findings suggest that, in this patient population, the choice of guidance method may not impact MACE outcome.