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Clinical Outcomes of Deferred Revascularisation Using Fractional Flow Reserve in Diabetic Patients
Mohammad Alkhalil1, Claire McCune1, Lisa McClenaghan1
1Department of Cardiology, Royal Victoria Hospital, Belfast, UK.
Insights
Diabetic patients undergoing fractional flow reserve (FFR)-guided deferred revascularisation face higher risks of cardiac death and myocardial infarction. However, FFR remains valuable for risk stratification in this population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diabetes Mellitus
Background:
- Diabetes is linked to increased atherosclerosis and microvascular dysfunction.
- Fractional flow reserve (FFR) assesses coronary lesion significance.
- FFR-guided deferred revascularisation outcomes in diabetics are understudied.
Purpose of the Study:
- To evaluate clinical outcomes in diabetic patients after FFR-guided deferred revascularisation.
- To compare outcomes between diabetic and non-diabetic patients.
- To assess the role of FFR in risk stratification for diabetic patients.
Main Methods:
- Prospective collection of clinical endpoints in patients undergoing FFR assessment.
- Primary endpoint: 4-year risk of cardiac death, vessel-related MI, or urgent revascularisation.
- Stratification by absolute FFR values (0.81-0.85, 0.86-0.90, >0.90).
Main Results:
- Diabetic patients had a significantly higher primary endpoint risk (HR 1.76, P=0.024).
- This difference was driven by cardiac death and vessel-related MI.
- FFR values effectively stratified risk in diabetic patients (P=0.001).
Conclusions:
- Diabetic patients have increased risks of death and MI with FFR-guided deferred revascularisation.
- FFR is a useful tool for identifying future risk, especially in diabetics.
- Deferred revascularisation guided by FFR shows risk stratification utility across FFR strata.
Background:
Fractional flow reserve (FFR) is used to assess the functional significance of coronary artery lesions. Diabetic patients are associated with high burden of atherosclerosis and microvascular dysfunction. We studied the clinical outcomes of diabetic patients who underwent FFR-guided deferred revascularisation.
Methods:
Consecutive patients from a single large volume centre who underwent FFR assessment were included. Clinical endpoints were prospectively collected using the national electronic care records system. The primary endpoint was defined as the four-year risk of the vessel-oriented composite outcome of cardiac death, vessel-related myocardial infarction (VMI), and vessel-related urgent revascularisation (VUR). Absolute FFR values groups (0.81 to 0.85; 0.86 to 0.90; and >0.90) were used to further stratify patient outcomes.
Results:
FFR-guided deferred revascularisation occurred in 860 patients (63%), of whom 159 were diabetic. The primary endpoint was significantly higher in the diabetic compared to the non-diabetic group [HR 1.76 (95%CI 1.08 to 2.88), P = 0.024]. The difference was driven from cardiac death (6.3% vs. 3.0%, P = 0.044) and VMI (5.0% vs. 1.7%, P = 0.012) but not VUR (8.8% vs. 5.1%, P = 0.07). There was a significant decrease in the incidence of the primary endpoint in the diabetic group according to FFR groups (23.6%, 12.3%, 2.4%, P = 0.001) with comparable clinical outcomes in the non-diabetic group (11.8%, 6.4%, 7.4%, P = 0.085).
Conclusions:
Our study demonstrated an increased risk of death and target vessel MI in diabetic patients undergoing FFR-guided deferred revascularisation compared to non-diabetic group. Nonetheless, FFR remained a useful tool to identify those at future risk, mainly in diabetic patients.
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