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Updated: May 20, 2026
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Very long-term clinical follow-up after fractional flow reserve-guided coronary revascularization
Louis H Miller1, Bora Toklu, Judah Rauch
1VA New York Harbor Health Care System New York Campus, New York, NY 10010, USA.
Insights
Fractional flow reserve (FFR) measurement safely guides percutaneous coronary intervention decisions for intermediate coronary lesions. Long-term outcomes show deferring revascularization based on FFR is safe, with similar cardiac event rates compared to intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Randomized trials confirm safety and efficacy of FFR-guided PCI for cardiac events.
- Real-world, long-term outcomes of FFR-based revascularization strategies remain largely unknown.
Purpose of the Study:
- To evaluate the long-term, real-world outcomes of deferring revascularization in intermediate coronary lesions based on FFR measurements.
- To assess the safety and efficacy of an FFR-guided revascularization strategy in a clinical setting.
Main Methods:
- Prospective data collected from patients with intermediate coronary lesions where revascularization decisions were unclear.
- FFR was measured, and revascularization was deferred if FFR > 0.8.
- Clinical outcomes including death, myocardial infarction, and late revascularization were tracked for up to 10 years.
Main Results:
- 151 patients were included; 37.7% underwent revascularization.
- Mean follow-up was 6.1 years, with 97% completion.
- No significant difference in survival (70.9% overall) or late revascularization rates (11.9% overall) between initial revascularization and deferred groups.
Conclusions:
- FFR is a valuable tool for coronary angiography, aiding in the selection of patients with intermediate lesions.
- FFR-guided deferral of revascularization is safe and effective in the long term.
- FFR assists in optimizing treatment strategies for coronary artery disease.
Background:
Randomized trials using measurement of fractional flow reserve (FFR) to guide percutaneous coronary intervention (PCI) have demonstrated both safety and efficacy with regard to cardiac events. Real-world, long-term outcomes using an FFR-based revascularization strategy are unknown.
Methods:
Prospective clinical data were collected on consecutive patients referred for coronary angiography and found to have lesions of intermediate severity where the operators were unable to make a decision regarding revascularization based on angiographic, clinical, and stress testing parameters. FFR was measured on intermediate lesions, and revascularization was deferred on those lesions with a measurement >0.8. Clinical outcomes of interest included death, myocardial infarction, and late revascularization status.
Results:
A total of 151 patients were included in this study. Fifty-seven patients (37.7%) underwent revascularization based on their FFR measurement. The mean length of follow-up was 6.1 years (range, 5-10 years). Follow-up was completed in 97.0%. At the end of the follow-up period, 107 patients (70.9%) were alive. Late revascularization had been performed in 18 patients (11.9%). Comparing the initial revascularization group with the group in which revascularization was deferred, 64.9% and 74.5% were alive, respectively (P=.29). Of the initial revascularization group, 12.3% had undergone late revascularization of the lesion on which FFR was originally performed, compared with 11.7% in the deferred group (P=.99).
Conclusions:
FFR is a useful adjunct to coronary angiography in selecting patients with lesions of intermediate angiographic severity in whom coronary revascularization may be safely deferred.
