Intravascular physiology and imaging in determining the indications for revascularization in patients with intermediate coronary stenosis

Objective. To compare functional and morphological indications for myocardial revascularization in patients with intermediate lesions of coronary arteries. Material and methods. Patients with coronary artery disease underwent functional (FFR/iFR) and morphological (OCT/IVUS) assessment of intermediate stenosis 40—70% (by diameter) to identify significance of lesions. Percutaneous coronary intervention was performed if indications for revascularization were identified according to one method. After 12 months, the following endpoints were assessed: recurrence of angina, myocardial infarction, all-cause mortality and target vessel revascularization. Results. The study included 49 patients with intermediate coronary artery stenosis. Coincidence of functional and morphological criteria was observed in 69% of cases. In 12% of patients, significant stenoses were detected by FFR in contrast to intravascular imaging. In 19% of patients, there were morphological criteria of significance, but hemodynamic effect of lesion was not confirmed by intravascular physiology. After 12 months, there was no significant difference in angina recurrence rate between groups of PCI and optimal therapy (8.3% and 4%, p=0.793). Conclusion. Thus, determining the strategy under control of intracoronary physiology and imaging allows us to identify functional and morphological criteria for revascularization. In turn, FFR/iFR was associated with lower frequency of detection of criteria for significance of intermediate lesions compared to IVUS/OCT. Percutaneous coronary intervention or avoiding revascularization in favor of optimal therapy did not demonstrate differences in the incidence of endpoints after a year.