Abstract: Objective To evaluate the long-term clinical outcomes of fractional flow reserve (FFR)-guided versus intravascular
ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) for intermediate coronary lesions. Methods A total of 226
patients with 293 intermediate coronary artery lesions (stenosis of 40%-70% ) confirmed by coronary angiography were
randomized into 3 groups to undergo PCI for a minimal lumen cross sectional area (MLA)<4 mm2 (IVUS group, 98 lesions) or
for a FFR<0.80 (FFR group, 101 lesions), or to receive standard medical treatment (medication group, 94 lesions). The primary
outcome was major adverse cardiac events including death, myocardial infarction, and ischemia-driven target vessel
revascularization at 1 year after the index procedure. Results The baseline percent diameter stenosis and lesion length were
similar between the 3 groups, but more patients in IVUS group than in FFR group received PCI (P<0.001). No significant
difference was found in the incidence of major adverse cardiac events between the 3 groups (P=0.182). Conclusions Both FFRand
IVUS-guided PCI strategy for intermediate coronary artery disease are associated with favorable outcomes, but
IVUS-guided PCI based on the single index of MLAcan increase the rate of revascularization therapy.