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Five-Year Outcomes After Fractional Flow Reserve-Guided Deferral of Revascularization in Infarct-Related Artery
Hirofumi Ohashi1, Shoichi Kuramitsu2, Hiroaki Takashima1
1Department of Cardiology, Aichi Medical University, Aichi, Japan.
Insights
Deferring revascularization in infarct-related artery lesions based on late fractional flow reserve (FFR) measurements after myocardial infarction (MI) is safe. Long-term outcomes showed no significant difference in target vessel failure between infarct-related and non-infarct-related lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Limited long-term safety data exists for deferring revascularization guided by fractional flow reserve (FFR) in infarct-related artery (IRA) lesions post-myocardial infarction (MI).
- FFR assessment in the late phase after MI requires further investigation for guiding treatment decisions.
Purpose of the Study:
- To evaluate the long-term safety and outcomes of deferring revascularization in IRA lesions.
- To assess the impact of late-phase FFR measurements on patient outcomes after MI.
Main Methods:
- Utilized data from the J-CONFIRM registry, analyzing 1447 lesions (1263 patients) divided into IRA and non-IRA groups.
- Primary endpoint was the 5-year cumulative incidence of target vessel failure (TVF), including cardiac death, target vessel-MI, and revascularization.
- FFR was measured at a median of 716 days post-MI.
Main Results:
- The infarct-related artery (IRA) group comprised 9.5% of lesions.
- Visual-functional mismatches were similar between IRA and non-IRA groups (31.9% vs 36.3%).
- The 5-year cumulative incidence of target vessel failure (TVF) was comparable between IRA (9.2%) and non-IRA (11.8%) groups, with no significant difference (p=0.71).
Conclusions:
- Deferring revascularization guided by late-phase FFR in infarct-related artery lesions post-MI is associated with similar long-term outcomes compared to non-IRA lesions.
- These findings support the use of FFR for deferring revascularization in IRA lesions, even in the late post-MI setting.
Background:
Little evidence is available about the long-term safety of fractional flow reserve (FFR)-guided deferral of revascularization in infarct-related artery (IRA) lesions, especially when measuring FFR in the late setting after myocardial infarction (MI). This study aimed to assess the long-term outcomes after deferral of revascularization in IRA lesions based on FFR assessed in the late phase of post-MI.
Methods:
From the J-CONFIRM registry (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry), data on 1447 lesions (1263 patients) were divided into 2 groups: the IRA and non-IRA groups. The primary study end point was the cumulative 5-year incidence of target vessel failure (TVF), such as cardiac death, target vessel-related MI, and clinically driven target vessel revascularization.
Results:
Of the 1447 lesions, 138 (9.5%) were classified into the IRA group. The median duration of FFR measurement was 716 days after MI. The frequency of visual-functional mismatches (ie, FFR >0.80 and percent diameter stenosis ≥50% or FFR ≤0.80 and percent diameter stenosis <50%) was comparable between the IRA and non-IRA groups (31.9% vs 36.3%). The cumulative 5-year incidence of TVF did not differ between the groups (9.2% vs 11.8%; inverse probability-weighted hazard ratio, 1.18, 95% confidence intervals, 0.48-2.91, P = .71). Similar results were observed irrespective of regional wall motion assessed by ultrasonic cardiography and acute MI type.
Conclusions:
The 5-year TVF rate did not differ between the IRA and non-IRA lesions when deferring revascularization guided by FFR in the late setting of post-MI.
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