@article{aa4d8ec4ec384b659161da799671dba9,
title = "Impact of Intravascular Ultrasound-Derived Lesion-Specific Virtual Fractional Flow Reserve Predicts 3-Year Outcomes of Untreated Nonculprit Lesions: The PROSPECT Study",
abstract = "BACKGROUND: Hemodynamic assessment of untreated nonculprit lesions was not studied in the PROSPECT study (Providing Regional Observations to Study Predictors of Events in the Coronary Tree). We developed a virtual intravascular ultrasound-derived lesion-specific fractional flow reserve (lesion-specific IVUS-FFR) algorithm to assess individual lesion-level FFR. We sought to investigate the relation between lesion-specific IVUS-FFR and major adverse cardiovascular events (MACE) arising from untreated nonculprit lesions in the PROSPECT study. METHODS: In PROSPECT, 697 patients with acute coronary syndromes underwent 3-vessel grayscale and virtual histology-IVUS to correlate untreated nonculprit plaque morphology with 3-year nonculprit related MACE (composite of cardiac death, cardiac arrest, myocardial infarction, or rehospitalization due to unstable or progressive angina). Lesion-specific IVUS-FFR was calculated from volumetric IVUS lumen area measurements at 0.4 mm intervals by applying a mathematical circulation model using basic fluid dynamics equations. RESULTS: Lesion-specific IVUS-FFR was analyzable in 3227 nonculprit lesions in 660 patients among whom 54 nonculprit MACE events (3 myocardial infarctions) occurred at median 3.4-year follow-up. By receiver-operating characteristic analysis, the best cutoff value of lesion-specific IVUS-FFR to predict nonculprit MACE was ≤0.95. After adjusting for patient and lesion characteristics, lesion-specific IVUS-FFR (hazard ratio, 4.83 [95% CI, 2.20-10.61]; P<0.001) was an independent predictor of 3-year nonculprit MACE, in addition to minimum lumen area≤4.0 mm2, plaque burden ≥70%, and virtual histology thin-cap fibroatheroma. CONCLUSIONS: Minor reductions in lesion-specific IVUS-FFR were independently associated with future nonculprit MACE arising from untreated angiographically mild stenoses along with previously established high-risk lesion morphological characteristics.",
keywords = "acute coronary syndromes, hemodynamics, ischemia, myocardial infarction, percutaneous coronary intervention",
author = "Fumiyasu Seike and Mintz, {Gary S.} and Mitsuaki Matsumura and Ali, {Ziad A.} and Mengdan Liu and Allen Jeremias and Ori Ben-Yehuda and {De Bruyne}, Bernard and Serruys, {Patrick W.} and Kazunori Yasuda and Stone, {Gregg W.} and Akiko Maehara",
note = "Funding Information: Dr Seike reports grant support and lecture fees from Abbott Vascular. Dr Mintz receives honoraria from Boston Scientific, Philips, Abiomed, and Medtronic. M. Matsumura is a Consultant for Terumo Corporation. Dr Ali reports institutional research grants to Columbia University from Abbott, Cardiovascular Systems, Inc; consultant for Abbott, Abiomed, AstraZeneca, Shockwave. Dr Jeremias receives institutional funding (unrestricted education grant) and serves as a consultant for Volcano/Philips and Abbott Vascular; consultant to ACIST Medical and Boston Scientific. Dr Bruyne receives institutional grant support from Abbott, Boston Scientific, and Biotronik AG; institutional consulting fees from Abbott, Opsens, and Boston Scientific. Dr Serruys serves as consultant for Sinomed, Philips/Volcano, Xeltis, SMT, Novartis, and Meril Life. Dr Stone receives speaker or other honoraria from Cook, Terumo, QOOL Therapeutics, and Orchestra Biomed; Consultant to Valfix, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Miracor, Neovasc, V-Wave, Abiomed, Ancora, MAIA Pharmaceuticals, Vectorious, Reva, Matrizyme, Cardiomech; Equity/options from Ancora, Qool Therapeutics, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, MedFocus family of funds, Valfix. Dr Maehara receives grant support from Abbott Vascular and Boston Scientific, consultant for Boston Scientific, Philips. The other authors report no conflicts. Funding Information: PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) was funded by Abbott Vascular (Santa Clara, CA) and Volcano Corporation (San Diego, CA). Publisher Copyright: {\textcopyright} 2022 American Heart Association, Inc.",
year = "2022",
month = nov,
day = "1",
doi = "10.1161/CIRCINTERVENTIONS.121.011198",
language = "English",
volume = "15",
pages = "851--860",
journal = "Circulation: Cardiovascular Interventions",
issn = "1941-7640",
publisher = "Lippincott Williams and Wilkins Ltd.",
number = "11",
}