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Published on: June 28, 2019
Long-term outcome after deferred revascularization due to negative fractional flow reserve in intermediate coronary
Jerremy Weerts1,2, Tobias Pustjens1,3, Elsa Amin1
1Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Insights
Deferring intervention for coronary lesions with fractional flow reserve (FFR) >0.80 is safe, but outcomes worsen with FFR values closer to the threshold. Multivessel disease and distal lesions increase risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Fractional flow reserve (FFR) guides percutaneous coronary intervention decisions.
- Deferring intervention for intermediate coronary lesions (FFR >0.80) is a common strategy.
- Outcomes for deferred lesions, especially those with FFR near the threshold, require further investigation.
Purpose of the Study:
- To evaluate the long-term outcomes of deferring intervention for coronary lesions with FFR >0.80 in a real-world setting.
- To identify predictors of deferred target lesion failure (DTLF) in this patient cohort.
Main Methods:
- Retrospective analysis of patients with deferred coronary interventions based on FFR >0.80.
- Primary endpoint: DTLF (acute coronary syndrome or revascularization of the initially deferred lesion).
- Analysis of patient demographics, lesion characteristics, and follow-up data.
Main Results:
- 7.3% DTLF rate observed over a mean follow-up of 27 months in 600 patients (751 lesions).
- Independent predictors for DTLF included lower FFR values (0.81-0.85), multivessel disease (MVD), distal lesions, and lesions in saphenous vein grafts (SVG).
- Diabetes mellitus and prior coronary artery bypass grafting were associated with DTLF but not independent predictors.
Conclusions:
- Long-term DTLF rate for deferred coronary lesions with FFR >0.80 is 7.3%.
- Lower FFR values, MVD, distal lesions, and SVG lesions are significant predictors of DTLF.
- Careful consideration and patient selection are warranted for deferred lesions with FFR values near the 0.80 threshold.
Objectives:
The aim was to assess long-term outcome after deferring intervention of coronary lesions with a fractional flow reserve (FFR) value of >0.80 in a real-world patient population and then to identify factors associated with deferred target lesion failure (DTLF).
Background:
Deferring coronary interventions of intermediate lesions based on FFR measurement is safe, irrespective of the extent of coronary artery disease. However, FFR values near the cut-off of >0.80 may have less favorable outcome.
Methods:
A retrospective analysis was performed in patients with deferred coronary intervention based on FFR value >0.80. The primary endpoint was DTLF, a composite of acute coronary syndrome (ACS) and any coronary revascularization, related to the initially deferred stenosis.
Results:
A total of 600 patients, mean age of 66 ± 10 years, and 751 coronary lesions with negative FFR values (mean 0.88 ± 0.04) were included. The mean follow-up was 27 ± 15 months. DTLF occurred in 44 patients (7.3%), revascularization in 42 (7%), and ACS without revascularization in 2 patients (0.3%). Patients with DTLF more often had diabetes mellitus, previous coronary artery bypass grafting, multivessel disease (MVD), and lower FFR at inclusion. Multivariable regression analysis showed that lower deferred FFR values [FFR 0.81-0.85: hazard ratio (HR) 2.79 (95% CI [confidence interval]; 1.46-5.32), p .002], MVD [HR 1.98 (95% CI; 1.05-3.75), p .036], distal lesions [HR 2.43 (95% CI; 1.29-4.57), p .006], and lesions located in a saphenous vein graft (SVG) [HR 6.35 (95% CI; 1.81-22.28), p .004] were independent predictors for DTLF.
Conclusions:
The long-term rate of DTLF of initially deferred coronary lesions was 7.3%. Independent predictors for DTLF are lower deferred FFR value, the presence of MVD, distal lesions, and lesions in SVG.
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