The Prognostic Value of Residual Coronary Stenoses After Functionally Complete Revascularization

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Assessing complete revascularization in multivessel coronary artery disease is crucial.
• Residual SYNTAX score (RSS) and SYNTAX revascularization index (SRI) are used to quantify angiographic completeness.
• The prognostic significance of residual lesions after FFR-guided functionally complete revascularization is not well understood.

Purpose of the Study:

• To evaluate the prognostic value of RSS and SRI after FFR-guided functionally complete revascularization.
• To determine if residual angiographic disease predicts outcomes when functional significance is addressed.

Main Methods:

• Analysis of the FFR-guided percutaneous coronary intervention (PCI) cohort from the FAME trial (n=427).
• Calculation of RSS (recalculated SYNTAX score post-PCI) and SRI (100 × (1 - RSS/baseline SS)).
• Comparison of 1- and 2-year outcomes based on RSS and SRI strata.

Main Results:

• Mean baseline SS was 14.4 ± 7.2, mean RSS was 6.5 ± 5.8, and mean SRI was 55.1 ± 32.5%.
• Major adverse cardiac events (MACE) at 1 year occurred in 12.4% of patients.
• No significant difference in RSS or SRI was observed between patients with and without MACE; Kaplan-Meier analysis showed similar MACE incidence across RSS/SRI strata.

Conclusions:

• Residual angiographic lesions, if not functionally significant by FFR, do not indicate residual ischemia or worse outcomes.
• Supports the strategy of achieving functionally complete revascularization guided by FFR.
• Emphasizes the importance of functional assessment over purely angiographic completeness in multivessel coronary artery disease management.