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Long-Term Patient-Related and Lesion-Related Outcomes After Real-World Fractional Flow Reserve Use
Joon-Hyung Doh, Chang-Wook Nam, Bon-Kwon Koo1
1Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744 Korea. bkkoo@snu.ac.kr.
Insights
Fractional flow reserve (FFR) guided decisions to defer stenting in coronary lesions show favorable long-term outcomes. However, diabetes and low FFR values (≤0.8) increase clinical event risk in deferred lesions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Real-world long-term outcomes of fractional flow reserve (FFR) use, including deferral decisions, remain under-evaluated in the era of drug-eluting stent (DES) implantation.
- Assessing the impact of FFR-guided treatment strategies is crucial for optimizing patient care in coronary artery disease.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of patients undergoing FFR measurement for de novo coronary lesions.
- To determine the impact of FFR-guided treatment strategies (stenting vs. deferral) on major adverse cardiac events and target-lesion related events.
Main Methods:
- A cohort of 1294 patients with de novo coronary lesions underwent FFR measurement.
- Lesions were categorized as FFR-deferred or FFR-stented based on treatment decisions post-FFR measurement.
- Clinical outcomes, including major adverse cardiac events and target-lesion related events, were assessed over a 5-year follow-up period.
Main Results:
- Mean FFR was 0.80 ± 0.12, with 44.7% of lesions having an FFR ≤0.8.
- Five-year cumulative event rates were: all-cause death 6.3%, myocardial infarction 1.5%, and any revascularization 12.5%.
- Deferred lesions with FFR ≤0.8 exhibited a higher risk of 5-year target-lesion related events (21.2%) compared to those with FFR >0.8 (6.6%). Diabetes and FFR ≤0.8 were independent predictors for 1-year and delayed events, respectively.
Conclusions:
- Deferral of stenting based on FFR measurements is associated with favorable long-term clinical outcomes.
- The presence of diabetes and an FFR value of ≤0.8 are significant risk factors for adverse clinical events in deferred lesions.
- FFR remains a valuable tool for guiding revascularization decisions, but patient-specific factors like diabetes must be considered.
Background:
Long-term clinical outcomes of real-world use of fractional flow reserve (FFR), including the decisions against FFR, have not been fully evaluated in the era of drug-eluting stent (DES) implantation.
Methods:
A total of 1294 patients who underwent FFR measurement for de novo coronary lesions were included. FFR measured lesions (n = 1628) were divided into FFR-defer or FFR-stent lesions according to the treatment strategy selected after FFR measurement. Clinical outcomes were assessed by patient-related major adverse cardiac event (a composite of all-cause death, myocardial infarction, and any revascularization) and target-lesion related event (target-lesion related myocardial infarction and revascularization).
Results:
Mean FFR was 0.80 ± 0.12, and FFR was ≤0.8 in 728 lesions (44.7%). Five-year cumulative all-death rate was 6.3%, myocardial infarction rate was 1.5%, and rate of any revascularization was 12.5%. Among 797 deferred lesions, 105 lesions had FFR ≤0.8 and those lesions had a higher risk of 5-year target-lesion related events than the lesions with FFR >0.8 (21.2% vs 6.6%, respectively; P=.03). By multivariate analyses, the determinant for the 1-year target-lesion related events was the presence of diabetes (hazard ratio, 3.74; 95% confidence interval, 1.45-9.67; P=.01), while the determinant for delayed events at 1-5 years was FFR ≤0.8 (hazard ratio, 4.50; 95% confidence interval, 1.65-12.28; P=.01). Angiographic lesion severity was not an independent predictor for clinical events during follow-up among deferred lesions.
Conclusion:
The deferral of stenting according to FFR was associated with favorable long-term outcomes. Presence of diabetes and low FFR (≤0.8) increased the risk of clinical events in deferred lesions.
