Fractional flow reserve in patients with reduced ejection fraction

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Fractional flow reserve (FFR) has not been previously studied in patients with reduced ejection fraction (LVEF ≤50%) and coronary artery disease (CAD).
• Evaluating FFR's impact on management strategies and outcomes in this specific patient population is crucial.

Purpose of the Study:

• To investigate the effect of FFR-guided revascularization versus angiography-guided management on clinical outcomes in patients with reduced LVEF and CAD.
• To assess the impact of FFR on revascularization rates and subsequent major adverse cardiovascular and cerebrovascular events (MACCE).

Main Methods:

• A retrospective study included patients with LVEF ≤50% undergoing coronary angiography between 2002 and 2010.
• Patients were divided into an FFR-guided group and an Angiography-guided group, with propensity score matching used for comparison.
• Outcomes, including all-cause death and MACCE, were compared between groups over a 5-year follow-up period.

Main Results:

• FFR guidance resulted in a significant downgrade of stenotic vessels compared to angiography alone (1.43 vs. 1.97 vessels; P < 0.001).
• The FFR-guided group showed lower revascularization rates (52% vs. 62%; P < 0.001).
• At 5 years, FFR-guided management was associated with significantly lower all-cause death (22% vs. 31%; P < 0.001) and MACCE (40% vs. 46%; P = 0.019) compared to the Angiography-guided group.

Conclusions:

• In patients with reduced LVEF and CAD, FFR-guided revascularization improves outcomes, leading to reduced death and MACCE rates at 5 years.
• FFR guidance facilitates conservative management, including less coronary artery bypass grafting and more percutaneous coronary intervention or medical therapy.
• The findings support the use of FFR to optimize treatment strategies in heart failure patients with concomitant coronary artery disease.