IMR Press / RCM / Volume 23 / Issue 11 / DOI: 10.31083/j.rcm2311361
Open Access Original Research
PCI Deferral Based on Fractional Flow Reserve or Optical Coherence Tomography: Two-Year Results of the Forza Trial
Show Less
1 Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Roma, Italy
2 Dipartimento di Scienze Cardiovascolari , Università Cattolica del Sacro Cuore, 00168 Roma, Italy
3 Cardiologia e Unità terapia intensiva, Policlinico Casilino, 00169 Roma, Italy
*Correspondence: (Antonio Maria Leone)
These authors contributed equally.
Academic Editors: Manuel Martínez-Sellés, Grigorios Tsigkas, Athanasios Moulias and Anastasios Apostolos
Rev. Cardiovasc. Med. 2022, 23(11), 361;
Submitted: 4 June 2022 | Revised: 25 July 2022 | Accepted: 10 August 2022 | Published: 25 October 2022
(This article belongs to the Special Issue Intravascular imaging and Cardiovascular intervention)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Backgroud: The “FFR or OCT Guidance to Revascularize Intermediate Coronary Stenosis Using Angioplasty” (FORZA) trial showed that in patients with angiographically intermediate coronary lesions (AICLs), optical coherence tomography (OCT) guidance of percutaneous coronary intervention (PCI) reduced the occurrence of the composite endpoint of major adverse cardiac events (MACE) or significant angina at 13 months, while fractional flow reserve (FFR) guidance was associated with a higher rate of medical management and with lower costs. Safety of PCI deferral when FFR >0.80 is known, while data on clinical outcomes using an OCT guidance are lacking. We assessed the safety of PCI deferral based on OCT findings. Methods: This is a subgroups analysis of the FORZA Trial focusing on the clinical outcome of patients in whom PCI was originally deferred. In details, patients with AICLs were randomized to FFR or OCT imaging. In the FFR arm, PCI was deferred if FFR was >0.80 while in the OCT arm in the absence of any of the following conditions: area stenosis >75%, or 50% to 75% with minimum lumen area <2.5 mm2 or plaque rupture. Angina status (evaluated using the Seattle Angina Questionnaire, SAQ), MACE (death, myocardial infarction, target vessel revascularization) and rate of patients treated with optimal medical therapy alone were assessed at 24 months. Results: From a total of 350 patients with 446 AICLs enrolled in the trial (176 randomized to FFR and 174 to OCT), based on the predefined FFR and OCT criteria, PCI was deferred in 119 patients (67.6%) in the FFR arm, and in 82 patients (47.1%) in the OCT arm. At 24-months follow-up, significant residual angina (defined as a value <90 on the angina frequency scale) was observed in 6 patients (5.0%) in the FFR arm, and in 6 patients (7.3%) in the OCT arm (p = 0.55). Rate of MACE was 10.9% in the FFR arm and 6.1% in the OCT arm (p = 0.32). The number of patients managed by optimal medical therapy alone was still significantly higher using FFR than OCT guidance also at 24 months (60.2% vs 44.2%, p = 0.0038). Conclusions: PCI-deferral based on OCT (using the FORZA trial criteria) is safe and associated with numerically less events at 24-months follow up. FFR guidance is still associated with a higher number of patients managed by optimal medical therapy alone.

fractional flow reserve
optical coherence tomography
personalized medicine
1105536/internal Academic Grants
Fig. 1.
Back to top