Coronary Physiology Guidance vs Conventional Angiography for Optimization of Percutaneous Coronary Intervention: The AQVA-II Trial

Simone Biscaglia, Filippo Maria Verardi, Andrea Erriquez, Iginio Colaiori, Marta Cocco, Anna Cantone, Graziella Pompei, Andrea Marrone, Serena Caglioni, Carlo Tumscitz, Carlo Penzo, Marco Manfrini, Antonio Maria Leone, Francesco Versaci, Gianluca Campo

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Background: The debate surrounding the efficacy of coronary physiological guidance compared with conventional angiography in achieving optimal post–percutaneous coronary intervention (PCI) fractional flow reserve (FFR) values persists. Objectives: The primary aim of this study was to demonstrate the superiority of physiology-guided PCI, using either angiography or microcatheter-derived FFR, over conventional angiography-based PCI in complex high-risk indicated procedures (CHIPs). The secondary aim was to establish the noninferiority of angiography-derived FFR guidance compared with microcatheter-derived FFR guidance. Methods: Patients with obstructive coronary lesions and meeting CHIP criteria were randomized 2:1 to receive undergo physiology- or angiography-based PCI. Those assigned to the former were randomly allocated to angiography- or microcatheter-derived FFR guidance. CHIP criteria were long lesion (>28 mm), tandem lesions, severe calcifications, severe tortuosity, true bifurcation, in-stent restenosis, and left main stem disease. The primary outcome was invasive post-PCI FFR value. The optimal post-PCI FFR value was defined as >0.86. Results: A total of 305 patients (331 study vessels) were enrolled in the study (101 undergoing conventional angiography-based PCI and 204 physiology-based PCI). Optimal post-PCI FFR values were more frequent in the physiology-based PCI group compared with the conventional angiography-based PCI group (77% vs 54%; absolute difference 23%, relative difference 30%; P < 0.0001). The occurrence of the primary outcome did not differ between the 2 physiology-based PCI subgroups, demonstrating the noninferiority of angiography- vs microcatheter-derived FFR (P < 0.01). Conclusions: In CHIP patients, procedural planning and guidance on the basis of physiology (through either angiography- or microcatheter-derived FFR) are superior to conventional angiography for achieving optimal post-PCI FFR values. (Physiology Optimized Versus Angio-Guided PCI [AQVA-II]; NCT05658952)
Lingua originaleEnglish
pagine (da-a)277-287
Numero di pagine11
RivistaJACC: Cardiovascular Interventions
Volume17
DOI
Stato di pubblicazionePubblicato - 2024

Keywords

  • angiography-derived FFR
  • complex and high-risk indicated procedures
  • percutaneous coronary intervention
  • microcatheter-derived FFR
  • fractional flow reserve

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