Author + information
- Eisuke Usui,
- Taishi Yonetsu,
- Tetsumin Lee,
- Tadashi Murai,
- Yoshihisa Kanaji,
- Masahiro Hoshino,
- Takayuki Niida,
- Masahiro Hada,
- Rikuta Hamaya,
- Mitsuaki Isobe and
- Tsunekazu Kakuta
Background: We sought to investigate the diagnostic efficiency of optical coherence tomography (OCT) to identify coronary ischemia determined by fractional flow reserve (FFR) in comparison with that of intravascular ultrasound (IVUS).
Methods: We investigated 203 de novo intermediate coronary lesions of 186 patients who underwent all of OCT, IVUS and FFR measurement. Diagnostic efficiency of minimal lumen area obtained by OCT (OCT-MLA) and IVUS (IVUS-MLA) for predicting FFR <0.75 was evaluated. Univariate and multivariate logistic regression analysis was performed to investigate the predictors of discrepancy of OCT-MLA and FFR.
Results: FFR was <0.75 in 71 (35%) lesions. In receiver-operating curve analysis, OCT-MLA showed a significantly better diagnostic efficiency (best cut-off value [BCV]: 1.39mm2; area under the curve [AUC]: 0.73; 95% confidence interval [CI]: 0.66 to 0.80) than IVUS-MLA (BCV: 2.57mm2; AUC: 0.62; 95% CI: 0.53 to 0.70) to identify functional ischemia (p <0.01). In IVUS analysis, incidence of false positive (IVUS-MLA ≤2.57mm2 and FFR ≥0.75) was 57.9%, and incidence of false negative (IVUS-MLA >2.57mm2 and FFR <0.75) was 24.4%. In OCT analysis, incidence of false positive (OCT-MLA ≤1.39mm2 and FFR ≥0.75) was 46%, and incidence of false negative (OCT-MLA >1.39mm2 and FFR <0.75) was 19%. There were a trend but no significant differences in the prevalence of false-positive and false-negative between OCT-MLA and IVUS-MLA (p=0.09). In multivariate analysis of OCT-MLA, age (odds ratio [OR]: 1.04; 95%CI: 1.00 to 1.09; p=0.04), non-left anterior descending artery (OR: 2.55; 95%CI: 1.17 to 5.57; p=0.02), angiographic reference diameter (OR: 0.21; 95%CI: 0.09 to 0.48; p <0.01) were independent predictors of false positive, while age (OR: 0.95; 95%CI: 0.91 to 1.00; p=0.04) and left ventricular ejection fraction (OR: 0.96; 95%CI: 0.92 to 1.00; p=0.03) were independent predictors of false negative.
Conclusions: Intravascular imaging was not interchangeable with FFR in clinical decision making, although OCT may provide superior discriminating efficacy to IVUS in detecting functionally significant stenosis, although low specificity of OCT-MLA should still be taken into account.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: Angiography, Intravascular Imaging and Interventional CT/MR
Abstract Category: 23. Interventional Cardiology: IVUS and Intravascular Physiology
Presentation Number: 1153-118
- 2017 American College of Cardiology Foundation