Efficacy of Optical Coherence Tomography-derived Morphometric Assessment in Predicting the Physiological Significance of Coronary Stenosis: Head-to-Head Comparison with Intravascular Ultrasound

Abstract

Aims: This study aimed to investigate the diagnostic efficacy of optical coherence tomography (OCT) in identifying functional significance via fractional flow reserve (FFR) compared with that of intravascular ultrasound (IVUS).

Methods and results: We investigated 203 de novo intermediate coronary lesions of 186 patients who underwent frequency-domain OCT, IVUS and FFR measurements. Diagnostic efficacy of the minimal lumen area (MLA) obtained by OCT (OCT-MLA) and IVUS (IVUS-MLA) in predicting an FFR <0.75 was evaluated. Receiver operating characteristic curve analysis showed that OCT-MLA had significantly better diagnostic efficacy than IVUS-MLA in identifying functional ischaemia. OCT analysis revealed that the incidence of false positives (OCT-MLA ≤1.39 mm2 and FFR ≥0.75) was 46% (41/90), whereas the incidence of false negatives (OCT-MLA >1.39 mm2 and FFR <0.75) was 19% (22/113). Multivariate analysis showed that older age, non-left anterior descending artery and smaller angiographic reference diameter were independent predictors of false-positive results using the OCT-MLA criteria, whereas younger age and low left ventricular ejection fraction were independent predictors of false-negative results.

Conclusions: Intravascular imaging is not interchangeable with FFR in clinical decision making. However, OCT may have superior efficacy to IVUS in detecting functional ischaemia. Discrepancies between OCT-MLA and FFR should be taken into account for OCT-guided decision making.