Why is this study important? 

• Fractional Flow Reserve (FFR) is an appropriate initial strategy to evaluate intermediate stenosis (40-70 % lesions) and compared to intravascular ultrasound (IVUS) there were fewer stents placed (44.5 % vs. 65.3 %).
• There were no statistically significant differences in the rates of death, myocardial infarction, or repeat revascularization in either the FFR or IVUS group (8.1 % vs 8,5 % (p< 0.001 for non-inferiority).
• A subgroup of patients who were managed medically had comparable outcome with the those who underwent PCI.

What question was this study supposed to answer?   

• First, head-to-head comparison of FFR guided vs IVUS guided PCI for intermediate coronary lesions. 

What did the study show?

• Clinical trial randomizing1682 stable coronary artery disease (CAD) patients, mean age of 65 with diabetes in 32.9 %, to either an FFR guided or IVUS guided PCI in a 1:1 ratio.
• Revascularization criteria: FFR ≤0.80 in the FFR group and minimal lumen area (MLA) ≤3 mm2 or 3 mm2 < MLA ≤ 4 mm2 and plaque burden >70% in the IVUS group 
• Patients were followed for two years and those who underwent PCI received dual antiplatelet therapy for 6-12 months.
• FFR-guided PCI for intermediate lesions is an appropriate initial strategy for intermediate lesions and results in reduced resource utilization (i.e., coronary stenting).

All editors: S. Tanveer Rab, MD, FSCAI