Debate. Revascularization of nonculprit lesions in ACS: physiology or OCT-guided or both? Perspective from imaging
QUESTION: What is the benefit of intravascular imaging modalities—specifically the optical coherence tomography (OCT)—in the context of nonculprit lesions of an acute coronary syndrome (ACS)? ANSWER: The publications of the COMPLETE and FLOWER MI clinical trials has changed the...
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| Format: | Article |
| Language: | English |
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Permanyer
2023-05-01
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| Series: | REC: Interventional Cardiology (English Ed.) |
| Online Access: | https://recintervcardiol.org/en/index.php?option=com_content&view=article&id=1069 |
| _version_ | 1797829843605258240 |
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| author | Josep Gómez-Lara |
| author_facet | Josep Gómez-Lara |
| author_sort | Josep Gómez-Lara |
| collection | DOAJ |
| description | QUESTION: What is the benefit of intravascular imaging modalities—specifically the optical coherence tomography (OCT)—in the context of nonculprit lesions of an acute coronary syndrome (ACS)? ANSWER: The publications of the COMPLETE and FLOWER MI clinical trials has changed the management of nonculprit lesions tremendously in patients with ACS jeopardizing the role of the pressure guidewire guiding the revascularization of these lesions.1,2 In the COMPLETE trial, angiography-guided complete revascularization reduced the rates of death and infarction compared to the optimal medical therapy (OMT).1 We should mention that over 80% of the lesions included had an angiographic percent diameter stenosis ≥ 70%.1 In the FLOWER MI trial that included less severe nonculprit lesions, pressure guidewire-guided complete revascularization reduced the number of lesions treated (45% fewer lesions) compared to angiography-guided complete revascularization with a similar rate of events in both strategies.2 However, a subanalysis of the group of patients treated with pressure guidewire guidance revealed that patients with fractional flow reserve (FFR) values ≤ 0.80 (stented according to protocol) had fewer events compared to patients with FFR values > 0.80 (treated with OMT).3 This has aroused controversy regarding the utility of the pressure guidewire in this context. Probably the reason why the FFR has... |
| first_indexed | 2024-04-09T13:27:33Z |
| format | Article |
| id | doaj.art-8af729c76de94580a9a8358754d37265 |
| institution | Directory Open Access Journal |
| issn | 2604-7322 |
| language | English |
| last_indexed | 2024-04-09T13:27:33Z |
| publishDate | 2023-05-01 |
| publisher | Permanyer |
| record_format | Article |
| series | REC: Interventional Cardiology (English Ed.) |
| spelling | doaj.art-8af729c76de94580a9a8358754d372652023-05-10T06:59:27ZengPermanyerREC: Interventional Cardiology (English Ed.)2604-73222023-05-015213914110.24875/RECICE.M23000365Debate. Revascularization of nonculprit lesions in ACS: physiology or OCT-guided or both? Perspective from imagingJosep Gómez-Lara0Servicio de Cardiología, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, SpainQUESTION: What is the benefit of intravascular imaging modalities—specifically the optical coherence tomography (OCT)—in the context of nonculprit lesions of an acute coronary syndrome (ACS)? ANSWER: The publications of the COMPLETE and FLOWER MI clinical trials has changed the management of nonculprit lesions tremendously in patients with ACS jeopardizing the role of the pressure guidewire guiding the revascularization of these lesions.1,2 In the COMPLETE trial, angiography-guided complete revascularization reduced the rates of death and infarction compared to the optimal medical therapy (OMT).1 We should mention that over 80% of the lesions included had an angiographic percent diameter stenosis ≥ 70%.1 In the FLOWER MI trial that included less severe nonculprit lesions, pressure guidewire-guided complete revascularization reduced the number of lesions treated (45% fewer lesions) compared to angiography-guided complete revascularization with a similar rate of events in both strategies.2 However, a subanalysis of the group of patients treated with pressure guidewire guidance revealed that patients with fractional flow reserve (FFR) values ≤ 0.80 (stented according to protocol) had fewer events compared to patients with FFR values > 0.80 (treated with OMT).3 This has aroused controversy regarding the utility of the pressure guidewire in this context. Probably the reason why the FFR has...https://recintervcardiol.org/en/index.php?option=com_content&view=article&id=1069 |
| spellingShingle | Josep Gómez-Lara Debate. Revascularization of nonculprit lesions in ACS: physiology or OCT-guided or both? Perspective from imaging REC: Interventional Cardiology (English Ed.) |
| title | Debate. Revascularization of nonculprit lesions in ACS: physiology or OCT-guided or both? Perspective from imaging |
| title_full | Debate. Revascularization of nonculprit lesions in ACS: physiology or OCT-guided or both? Perspective from imaging |
| title_fullStr | Debate. Revascularization of nonculprit lesions in ACS: physiology or OCT-guided or both? Perspective from imaging |
| title_full_unstemmed | Debate. Revascularization of nonculprit lesions in ACS: physiology or OCT-guided or both? Perspective from imaging |
| title_short | Debate. Revascularization of nonculprit lesions in ACS: physiology or OCT-guided or both? Perspective from imaging |
| title_sort | debate revascularization of nonculprit lesions in acs physiology or oct guided or both perspective from imaging |
| url | https://recintervcardiol.org/en/index.php?option=com_content&view=article&id=1069 |
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