Treatment of stable patients: pro and contra of functional

(FFR-IFR) vs anatomical (IVUS-OCT) based strategy

Laura Gatto, MD
Azienda Ospedaliera San Giovanni Addolorata Roma
C.L.I. Onlus Foundation
Engstrom T et al, Lancet 2015
Smits PC et al, NEJM 2017
ESC Guidelines on Myocardial Revascularization (2018)
ESC Guidelines on Myocardial Revascularization (2018)
IVUS and OCT: pro and contra
 Imaging and stenting guidance

Raber L. et al ,
European Heart Journal 2018
Meta-analyses of IVUS vs angiography-guided DES-PCI

2014

2014
 Major Adverse Cardiovascular Events
26.503 patients from 3 RCT and 14 observational studies

Ahn JM et al Am J Cardiol, 2014

 Death Myocardial Infarction

Periprocedural MI did
not significantly differ
between two groups

Target Vessel Revascularization Stent Thrombosis

Ahn JM et al Am J Cardiol, 2014

Procedural Findings

Ahn JM et al Am J Cardiol, 2014

ADAPT-DES Results
 STUDIES on OCT guided PCI

335 pts OCT Reduced rate of cardiac death and MACE in patients who underwent
CLIO-PCI I Euroint 2012 guided vs 335 pts OCT-guided interventions
angio guided

Pre-stenting OCT changed the PCI strategy more frequently (57%)

ILLUMIEN E.H.J. 2015 418 pts compared with OCT performed after stenting (27% )

354 OTC guided

ILLUMIEN II JACC Interv PCI and 586 IVUS OCT and IVUS guidance resulted in a comparable degree of stent
guided PCI expansion

450 pts (158 OCT, OCT was not found to be superior to angiography with respect to MSA
ILLUMIEN III Lancet 2016 146 IVUS, 146 but led to significantly improved minimum and mean stent expansion
angio) and fewer untreated dissections and persisting major malapposition

OCT-guided PCI was associated with a small but significant

DOCTORS Circulat 2016 240 pts NSTEMI improvement in post procedural FFR compared to angio-guided PCI
The CLI-OPCI II Study: 1002 lesions with final OCT assessment
Prevalence of suboptimal stent implantation in 31% of cases

Prati F, Gatto L, et al, JACC Cardiovasc Imaging, 2015

The CLI-OPCI II Study: 1002 lesions with final OCT assessment

Prati F, Gatto L, et al, JACC Cardiovasc Imaging, 2015

Engstrom T et al, Lancet 2015
Smits PC et al, NEJM 2017
 CLIMA TRIAL

Prati F. , Gatto L, et al EHJ 2019

 INTERCLIMA STUDY DESIGN

Courtesy of Prof. F. Prati

 CONCLUSION:

❖ FFR guided PCI of intermediate lesions improves the clinical outcome compared to an

angio guided approach

❖ The use of FFR is associated with a great reduction in the incidence of new coronary

revascularization, but there are no consistent data on the efficacy of an FFR guided

approach for reducing hard end-points

❖ IC imaging modalities allow to optmize stent implantation preventing stent failure

❖ IC imaging modalities can identify patients with more aggressive atheroscleorsis that

may be responsible of further clinical events

❖ We wait for the results of ongoing trials!!!