Outcomes of Deferred Revascularization Following Physiological Coronary Assessment Using Fractional Flow Reserve

Abstract

Objective Outcomes of patients with deferred revascularization for intermediate stenosis coronary lesion based upon physiological assessment using fractional flow reserve ([FFR] >0.80). Methods Patients with chest pain with angiographic intermediate stenosis, (40–70% stenosis) without noninvasive test evidence of ischemia were selected and underwent an FFR assessment between January 1, 2015, and August 31, 2018. Patients with intermediate lesions of FFR > 0.80 were followed, and those patients with lesion with FFR < 0.8 were excluded from the study. The primary outcomes of the study were to know the composite of target lesion revascularization (TLR), myocardial infarction (MI), and other vascular complications (major adverse cardiovascular events [MACE]). Results In 102 patients who underwent deferred revascularization (FFR > 0.80), 104 FFR studies were done and followed over one year. Four patients needed target lesion revascularization (3.92%). Three patients underwent percutaneous coronary intervention (2.94%) within nine months of follow-up, and one patient underwent coronary artery bypass graft (CABG) (0.98%) at one year of follow-up. Two patients died with acute MI with sudden cardiac arrest (1.96%). Two patients developed right hemiparesis (2.94%) on one year of follow-up due to acute ischemic stroke of a middle cerebral artery, and one patient underwent permanent pacemaker implantation for complete heart block (CHB). The incidence of the total events was 8.82%, TLR was 3.92%, Coronary event rate was 5.88%, and MACE was 7.84%. Conclusions Our study shows that there was a significant increase in the incidence of coronary event rate (5.88%) and the MACE rate (7.84%) in patients of deferred coronary revascularization based on higher FFR values (>0.8).

FFR—Is It Reliable and Sufficient Tool in Stable Patients?

“…The three important randomized controlled trails on FFR (FAME-2, 5 DANAMI-3-PRIMULTI, 6 and COMPARE-ACUTE 7 ), where deferred revascularization depending on the FFR value, showed that it was safer, even though the last two trials were done in acute coronary syndrome (ACS) patients. On contrary, this present study 8 shows that the incidence of target lesion failure in intermediate stenosis with deferred revascularization (FFR > 0.8) was high (5.8%).…”

“…Shabbir et al, 8 in their study, suggested that predicting 1-year rates of deferred lesion intervention (DLI) based on simple characteristics available at the time of index FFR measurement was presence of diabetes mellitus, left ventricular dysfunction, and ACS presentation. But this proposition is also controversial.…”