Combining OCT and FFR for Decision-Making in PCI: Insights from the FUSION Study-Combining OCT and FFR for Decision-Making in PCI: Insights from the FUSION Study

Video Transcription

Video Summary

This discussion centers on the Fusion Study, which evaluates the combination of optical coherence tomography (OCT) and fractional flow reserve (FFR) for guiding percutaneous coronary intervention (PCI). Dr. Alan Jeremias and colleagues demonstrate that integrating OCT imaging with physiology-based FFR measurements provides a more precise assessment than either alone. The combination aids clinical decision-making by identifying who benefits from PCI and optimizing stent sizing and placement, leading to improved outcomes.<br /><br />The Fusion Study showed that physiology primarily drives treatment decisions, but OCT significantly changes stent dimensions in about 60% of cases. Retrospective analyses confirm that achieving both optimal post-PCI minimal stent area (via imaging) and FFR improvement correlates with lower two-year adverse event rates. Experts emphasize the complementary nature: FFR guides whether to intervene, OCT guides how to intervene.<br /><br />Challenges include limitations of VFR (virtual FFR calculated from OCT) such as imaging length restriction and assumptions in flow modeling. Nevertheless, the integrated approach simplifies procedures with AI support and offers potential cost and time efficiencies. Panelists advocate for routine use of physiology and imaging in PCI, noting that intravascular imaging improves outcomes across simple and complex lesions despite reimbursement and training barriers. Overall, the combined FFR-OCT approach represents a significant advance toward precision coronary intervention and better patient care.

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Keywords

Fusion Study

optical coherence tomography

fractional flow reserve

percutaneous coronary intervention

stent optimization

physiology-based assessment

intravascular imaging