Fractional flow reserve (FFR)-guided treatment and intravascular ultrasound (IVUS)-guided treatment for intermediate coronary stenosis result in similar long-term clinical outcomes, a new study shows. These data were presented by Bon Kwon Koo, MD, PhD, from the Seoul National University Hospital, on Thursday during a Late-Breaking Trial session at the EuroPCR Congress 2025 in Paris. The randomized, open-label trial revealed that the primary endpoint, a composite of all-cause death, myocardial infarction (MI) and any revascularization, showed no statistically significant difference between the two groups. “We observed event rates of 22.6% in the FFR group versus 20.4% in the IVUS group, with a hazard ratio of 0.88 (P=0.228), which is not significant,” said the research team. Despite this finding, notable differences occurred in the revascularization rate with the FFR group experiencing a higher rate of revascularization (14.9% vs. 11.8%, P=0.049), particularly for target vessel revascularization (9.7% vs. 6.2%, P=0.007). Further investigations suggested this increase was driven by procedures performed between years two and seven post-enrollment, particularly in vessels where intervention had initially been deferred. Despite this, the overall rate of percutaneous coronary intervention (PCI) that included both the index procedure and follow-up interventions, was significantly lower in the FFR group (38.8% vs. 60.5%, P<0.001). They conclude that while both strategies are valid the choice may depend on institutional preference and patient-specific considerations. “As there was no difference in rates of death or MI, these results reinforce that a lower PCI burden in the FFR group did not compromise clinical safety,” noted the research team. Methodology The randomized, open-label, multinational trial was conducted at 18 sites across Korea and China. Participants were 19 years or older and a total of 1,682 patients were enrolled. Participants were randomly assigned in a 1:1 ratio to receive either FFR-guided treatment (n=838) or IVUS-guided treatment (n=844). The aim was to compare long-term outcomes of FFR-guided versus IVUS-guided treatment strategies in patients with intermediate coronary stenosis. The primary endpoint of the study was a composite of all-cause death, MI and any revascularization. Patients were followed for a median of 6.3 years (interquartile range: 5.6–6.9 years), with an extended follow-up continuing until September 2024. Image Credit: ronstik– stock.adobe.com