The safety profile of deferred revascularization in patients with coronary artery disease undergoing non-hyperemic functional assessments
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Published on: August 25, 2023
Mikołaj Błaziak1,2, Szymon Urban3, Weronika Wietrzyk2
1Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
Insights
Deferred revascularization using non-hyperemic indices like diastolic pressure ratio (dPR) and resting full-cycle ratio (RFR) is safe for coronary artery disease (CAD) patients. Outcomes at one year were comparable to fractional flow reserve (FFR) guided decisions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Fractional flow reserve (FFR) is the standard for coronary artery disease (CAD) functional evaluation.
- Non-hyperemic indices, including diastolic pressure ratio (dPR) and resting full-cycle ratio (RFR), are gaining clinical use.
- Limited data exist on the safety and long-term outcomes of deferred revascularization guided by non-hyperemic indices.
Purpose of the Study:
- To assess the safety of deferred revascularization in CAD patients using dPR and RFR.
- To compare the 1-year clinical outcomes of deferred revascularization based on non-hyperemic indices.
Main Methods:
- A prospective study screened patients undergoing functional coronary evaluations between January and June 2022.
- 204 patients with CAD underwent deferred revascularization based on dPR and RFR assessments.
- Primary endpoints included major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction (MI), and target vessel revascularization (TVR) at 1-year follow-up.
Main Results:
- The study included 204 patients (mean age 68.2 years, 76.8% male) with chronic coronary syndrome, unstable angina, or heart failure.
- Positive findings were observed in 17.4% of lesions assessed with dPR and 13.2% with RFR.
- At 1-year follow-up, MACE occurred in 7.8% of patients, with 4.9% all-cause mortality, 0.5% MI, and 2.5% TVR.
Conclusions:
- Deferred revascularization guided by dPR and RFR is safe in patients with CAD.
- The observed outcomes are comparable to those reported for FFR-guided revascularization.
- Larger randomized trials are warranted to validate these findings and establish definitive guidelines.
Introduction:
Fractional flow reserve (FFR) remains the gold standard for functional evaluation in coronary artery disease (CAD). However, non-hyperemic indices, such as diastolic pressure ratio (dPR) and resting full-cycle ratio (RFR), are increasingly utilized in clinical practice. Data on the safety and long-term outcomes of deferred revascularization based on these indices remain limited.
Aim:
This study aimed to evaluate the safety of deferred revascularization in patients with CAD using dPR and RFR indices.
Material And Methods:
Between January and June 2022, all consecutive patients undergoing functional coronary evaluations at a large tertiary hospital were screened. Primary endpoints included major adverse cardiovascular events (MACE), a composite of all-cause mortality, myocardial infarction (MI), and target vessel revascularization (TVR), along with individual endpoints at 1-year follow-up.
Results:
Of 321 patients evaluated, 290 met the eligibility criteria, and 204 underwent deferred revascularization based on non-hyperemic assessments. The cohort had a mean age of 68.2 years (SD ±8.9), with 76.8% male. Chronic coronary syndrome (57.2%), unstable angina (13.8%), and heart failure (9.3%) were the primary indications for coronary angiography. Among 230 lesions assessed with dPR and 243 with RFR, positive findings were observed in 17.4% and 13.2%, respectively (p = 0.15). At 1-year follow-up, MACE occurred in 7.8%, all-cause mortality was 4.9%, MI was 0.5%, and TVR was 2.5%.
Conclusions:
Deferred revascularization guided by dPR and RFR appears safe, with outcomes comparable to FFR-guided decisions in the literature. Larger randomized trials are needed to confirm these findings.
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