Long-term Outcome Of Intravascular Ultrasound Application In Patients With Moderate Coronary Lesions And Grey-zone Fractional Flow Reserve

Objective:With the development of percutaneous coronary intervention, coronary angiography in hospitals at all levels have been quite popular. The treatment of coronary borderline lesions is different. This study aimed to assess the long-term outcome of intravascular ultrasound (IVUS) application in patients with a fractional flow reserve (FFR) of 0.75 to 0.80.Methods:Patients (n=128) were divided into three groups based on treatment:drug control group (n=40), IVUS-percutaneous coronary intervention (PCI) group (n=40) and IVUS-drug group (n=48). A PCI was performed when a patient had an MLA<4 mm2 and a plaque burden≥70%. Major adverse clinical events (MACE) were defined as cardiac death; non-fatal myocardial infarction (MI); target vessel revascularization (TVR), including PCI or coronary artery bypass grafting (CABG); and unstable angina, all of which were also evaluated during follow-up.Results:. The incidences of dyslipidaemia and diabetes (68% vs.25%, P<0.001; 58% vs 27%, P=0.004) and the percentage of taking statin medicine (75% vs.40% P=0.001) increased in the IVUS-PCI group compared with the IVUS-drug group respectively. However, the incidences of dyslipidaemia, diabetes and the percentage of taking statin medicine decreased in the IVUS-drug group compared with the drug control group (25% vs.55%, P=0.004; 27% vs.55%, P=0.008,40% vs.68% P=0.009 respectively). Means and standard deviations in the left ventricular ejection fraction (50.6±4.2 vs. 52.9±3.3, P=0.02) decreased in the IVUS-PCI group compared with the IVUS-drug group, respectively. Other clinical conditions did not differ significantly among the three groups (P>0.05). Kaplan-Meier curves indicated that the incidence of MACE did not differ between the IVUS-PCI and IVUS-drug groups (5% vs.6.3%, P=0.810), but the levels in both of these groups significantly decreased compared with the drug control group (5% vs.22.5%, P=0.024, and 6.5% vs.22.5%, P=0.026, respectively).Conclusions:The long-term outcome of the application of intravascular ultrasound in patients with a grey-zone FFR of 0.75 to 0.80 was superior to that of patients who were treated only with drugs without IVUS measurement. Patients with a grey-zone FFR should receive an individualized treatment strategy according to their intravascular ultrasound parameters. Patients with the same FFR values may require different treatment strategies.