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Vessel-Specific Differences in Fractional Flow Reserve Among Intermediate Coronary Lesions
Victor Weerts1, Cedric Davidsen1, Mathieu Lempereur1
1Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA) Cardiovascular Sciences, Centre Hospitalier Universitaire (CHU) Sart Tilman, Department of Cardiology, University of Liège Hospital, 4000 Liège, Belgium.
Fractional flow reserve (FFR) indicates that intermediate coronary stenoses have different functional significance by coronary artery, with LAD lesions more often reaching ischemic thresholds. However, deferring revascularization based on negative FFR shows favorable long-term outcomes across all vessels.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Physiology
Background:
- Fractional flow reserve (FFR) is the gold standard for assessing intermediate coronary stenoses.
- A universal ischemic threshold for FFR is applied despite potential physiological differences between coronary territories.
- The study investigates if FFR values and outcomes differ by coronary artery.
Purpose of the Study:
- To evaluate if the functional significance of intermediate coronary stenoses varies by coronary artery.
- To assess the clinical outcomes of FFR-guided revascularization deferral across different coronary territories.
Main Methods:
- Single-center retrospective study of 310 patients with intermediate coronary lesions assessed by FFR (2019-2022).
- Exclusion of left main disease and multivessel physiological assessments.
- Analysis of FFR values and major adverse cardiovascular events (MACE) stratified by coronary artery (LAD, RCA, LCX).
Main Results:
- Overall, 18.7% of lesions had positive FFR (≤0.80), significantly associated with the coronary artery evaluated (p < 0.001).
- Positive FFR was found in 24.6% of LAD lesions vs. 8.8% in RCA and 0% in LCX.
- Five-year MACE-free survival was similar for deferred revascularization in patients with negative FFR across territories (p = 0.12).
Conclusions:
- The functional significance of intermediate coronary stenoses differs by coronary territory, with LAD lesions more frequently meeting ischemic criteria.
- Deferral of revascularization guided by negative FFR is associated with favorable long-term outcomes irrespective of the coronary artery.
- Results support a vessel-specific physiological interpretation of coronary stenoses.
