Additional Value of Optical Coherence Tomography‐Derived Virtual Flow Reserve for Percutaneous Coronary Intervention Guidance

ABSTRACT Background The combination of imaging and physiology could provide the best guidance for complex and high‐risk interventional procedures (CHIP). Aims The objective of the present study is to evaluate the difference in percutaneous coronary intervention (PCI) planning in CHIP patients between angiography, angiography‐derived fractional flow reserve (FFR), and the combination of imaging and physiology by means of optical coherence tomography plus virtual flow reserve (OCT‐VFR). Secondary objectives were to evaluate disease pattern, virtual stent length, and RVD according to the different plans. Methods Among patients included in the AQVA‐I and II trials, we selected those receiving OCT ( n = 114). Physiology reconstruction based on OCT traces was obtained in 97 patients. One operator, blinded to the actual procedural plan and to post‐PCI result, planned the procedure according to angiography, angiography‐derived FFR, OCT, and OCT‐VFR. Results OCT‐VFR plan was different compared to angiography and angiography‐derived FFR plans in 48% and 30% of the cases, respectively. OCT‐VFR plan was also different from OCT plans in 25% of the cases, mainly because of a different disease pattern leading to shorter treatment. Pattern of disease was more frequently focal in the angiography‐derived FFR plan if compared to OCT‐VFR plan ( p < 0.01). Stent length was different across different plans ( p for trend < 0.001) with angiography‐derived FFR with the shortest and OCT with the longest, respectively. Conclusions OCT‐VFR provided a different PCI plan than both angiography and angiography‐derived FFR in more than one‐third of the cases. If compared to OCT alone, the OCT‐VFR plan was significantly shorter in terms of stent length. Trial Registration ClinicalTrials.gov NCT05658952, NCT04664140.