Long-term follow-up after deferral of coronary intervention based on myocardial fractional flow reserve measurement

Background: Many studies have demonstrated that deferral of percutaneous coronary intervention (PCI) on the basis of a myocardial fractional flow reserve (FFR) ≥0.75 is associated with a very low coronary event rate. However, some groups have empirically chosen the cut-off value of 0.80 rather than 0.75 for decision to defer PCI and the FFR measurement between 0.75 and 0.80 has been established as a grey zone. The aim of this study was to evaluate the long-term clinical outcomes of patients with moderate coronary lesions and FFR measurements between 0.75 and 0.80. Methods: The study included 125 anigiographically moderate coronary lesions (>50% diameter stenosis by visual assessment) in 125 patients but in whom the PCI was deferred on the basis of an FFR ≥ 0.75. The FFR was calculated as the ratio of mean distal pressure divided by the proximal pressure during hyperemia. Patients were divided into two groups according to the result of FFR: ≥ 0.80 (n=99, group 1) and between 0.75 and 0.79 (n=26, group 2). We evaluated the long-term major adverse cardiovascular events (MACE) related and unrelated to the FFR-evaluated lesion. Results: During a follow-up period of 82 ± 29 months (mean ± SD), The Kaplan-Meier event-free survival curves showed that group 2 was poorer than group 1 in prognosis (p=0.0148). The incidence of MACE unrelated FFR-evaluated lesion in group 1 was equivalent to that in group 2 (p=0.96). Conclusions: In patients with moderate coronary lesions and borderline FFR measurements, deferral of PCI was associated with a higher rate of MACE related to the FFR-evaluated lesion. FFR cut-off point of 0.80 instead of 0.75 may be more appropriate for deferring PCI.

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TCT-420: Very Long-term Clinical Follow-up After Fractional Flow Reserve-Guided Coronary Revascularization

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2010.08.490 ◽

2010 ◽

Vol 56 (13) ◽

pp. B96

Keyword(s):

Fractional Flow Reserve ◽

Coronary Revascularization ◽

Fractional Flow ◽

Flow Reserve

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FRACTIONAL FLOW RESERVE AFTER FUNCTIONALLY OPTIMIZED CORONARY INTERVENTION (FCI) PREDICTS LONG-TERM OUTCOMES

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)32083-0 ◽

2020 ◽

Vol 75 (11) ◽

pp. 1456

Author(s):

Shiv Kumar Agarwal ◽

Abdul Hakeem ◽

Rimsha Hasan ◽

Mohamed Ayan ◽

Aisha Siraj ◽

...

Keyword(s):

Fractional Flow Reserve ◽

Coronary Intervention ◽

Fractional Flow ◽

Long Term Outcomes ◽

Flow Reserve

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Abstract 14304: Assessing the Association of Adherence to Fractional Flow Reserve Treatment Thresholds and Outcomes of Patients With Coronary Artery Disease

Circulation ◽

10.1161/circ.142.suppl_3.14304 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Maneesh Sud ◽

Lu Han ◽

Maria Koh ◽

Peter Austin ◽

Michael E Farkouh ◽

...

Keyword(s):

Medical Therapy ◽

Fractional Flow Reserve ◽

Coronary Intervention ◽

Routine Practice ◽

Cardiac Events ◽

Fractional Flow ◽

St Segment Elevation ◽

Single Vessel ◽

Flow Reserve

Background: Although fractional flow reserve (FFR) thresholds have been established to guide the use of percutaneous coronary intervention (PCI) or medical therapy, little is known about the adherence to FFR thresholds for PCI in clinical practice and their association with clinical outcomes. Methods: Adults undergoing FFR assessment in a single vessel (excluding ST-segment elevation myocardial infarction [MI]) from April 1, 2013 to March 31, 2018 in Ontario, Canada were included. Patients were divided into two cohorts based on FFR ≤ 0.80 (ischemic) and > 0.80 (non-ischemic). Inverse probability of treatment weighting was used to balance confounders between patients treated with PCI vs. no PCI in each cohort. The primary outcome was major adverse cardiac events (MACE) defined by death, MI, unstable angina, or urgent revascularization. Results: We identified 9,106 patients who underwent single-vessel FFR measurement. Among the 2,693 patients with an ischemic FFR (mean age 65, 27.0% female), 75.3% of patients received PCI and 24.7% were treated only with medical therapy. Over a median follow-up of 2.6 years in the ischemic cohort, PCI was associated with a 20% lower rate of MACE compared to no PCI (24.0% vs. 31.6%; hazard ratio [HR]: 0.80, 95% CI: 0.66-0.96). However, among 6,413 patients with a non-ischemic FFR (mean age 66, 38.9% female), 12.6% received PCI and 87.4% were treated only with medical therapy. Over a median follow-up of 2.8 years in the non-ischemic cohort, PCI was associated with a 42% higher rate of MACE compared to no PCI (25.6% vs. 17.6%; HR: 1.42, 95% CI: 1.18-1.70). The increased rate of MACE was driven mainly by MI (HR 1.67, 95% CI: 1.20-2.31) but not death (HR 0.99, 95% CI: 0.72-1.35). Conclusions: In routine practice, we found 1 in 4 patients did not receive PCI for ischemic lesions while 1 in 8 received PCI for non-ischemic lesions. Performing PCI procedures according to recommended FFR cutoffs was associated with lower rates of clinical events.

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