Usefulness of Fractional Flow Reserve Measurements to Defer Revascularization in Patients With Stable or Unstable Angina Pectoris, Non–ST-Elevation and ST-Elevation Acute Myocardial Infarction, or Atypical Chest Pain

Potvin, Jeannot; Rodés‐Cabau, Josep; Bertrand, Olivier; Gleeton, Onil; Nguyen, Can M.; Barbeau, Gérald; Proulx, Guy; Larochellière, Robert De; Déry, Jean‐Pierre; Batalla, Nuria; Dana, Ali; Facta, Alvaro D.; Roy, Louis

doi:10.1016/j.amjcard.2006.02.032

Cited by 55 publications

(37 citation statements)

References 28 publications

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“…The short-term, as well as long-term efficacy and safety of deferring revascularization when FFR is ≥0.75 has also been documented by several trials. 3,15,16,22 However, as Courtis et al 23 rightfully note, only a minority of these studies exhibited FFR values in the gray-zone range and reported mean FFR values of >0.85. Some investigators reported on individual patients who had detectable ischemia above the FFR cut-off of 0.75.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome Following Conservative vs Revascularization Therapy in Patients With Stable Coronary Artery Disease and Borderline Fractional Flow Reserve Measurements

Lindstaedt¹,

Halilcavusogullari²,

Yazar³

et al. 2010

Clinical Cardiology

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Background: Fractional flow reserve (FFR) measurements in the so-called gray-zone range of 0.75 and 0.80 are associated with uncertainty concerning the guidance of patient therapy. It is unclear whether any difference in clinical outcome exists when revascularization treatment of FFR-evaluated lesions in this borderline range is deferred or performed. The objective of this study is to compare the clinical outcome of these patients with respect to their recommended treatment strategy. Methods: Out of a single center database of 900 consecutive patients with stable coronary artery disease, 97 patients with borderline FFR measurements were identified and included in the study. The rate of major adverse cardiac events (MACE; cardiac death, myocardial infarction (MI), coronary revascularization) and the presence of angina were evaluated at follow-up. Results: A total of 48 patients were deferred from revascularization and 49 patients underwent revascularization. There was no difference in risk profile between these groups. At a mean follow-up of 24 ± 16 months, event-free survival in the deferred group was significantly better regarding overall MACE, combined rate of cardiac death, and MI, as well as MACE related to the FFR-evaluated vessel. No difference with regard to the presence of angina was observed. Conclusions: Patients with coronary lesions in the borderline FFR range can be deferred from revascularization without putting them at increased risk for major adverse events. Revascularization may be considered in the course of therapy on an individual basis if typical angina persists or worsens despite maximal medical treatment.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcome Following Conservative vs Revascularization Therapy in Patients With Stable Coronary Artery Disease and Borderline Fractional Flow Reserve Measurements

Lindstaedt¹,

Halilcavusogullari²,

Yazar³

et al. 2010

Clinical Cardiology

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show abstract

“…FFR has been shown to correlate well with non-invasive modalities such as perfusion scintigraphy, stress echocardiography and bicycle exercise [13][14][15], and prognostic studies support that deferral from revascularization in patients with an FFR N0.75 results in good clinical outcomes [16][17][18]. Furthermore, measurements of FFR can be performed in combination with invasive CAG, thus combining morphologic and functional information in one procedure enabling ad hoc percutaneous revascularization.…”

Section: Introductionmentioning

confidence: 97%

Correlation between coronary computed tomographic angiography and fractional flow reserve

Kristensen

Engstrøm

Kelbæk

et al. 2010

International Journal of Cardiology

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“…88% of patients were free from angina or had class I angina at 1 year based on the Canadian Cardiovascular Society angina class. Therefore, patients with coronary lesions can be managed safely without revascularization if the FFR is >0.75 [10]. In a further study the outcomes in 111 patients who had revascularization deferred with an FFR >0.75 was assessed at 12 months.…”

Section: Discussionmentioning

confidence: 99%

Pressure Wire Assessment in Patients with An Acute Coronary Syndrome

Rashid¹

2017

Interv Cardiol J

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Patients with stable coronary artery disease with a fractional flow reserve (FFR) of >0.75 to 0.8 can be safely managed with medical therapy with lower major adverse cardiac events. This avoids the risks associated with percutaneous coronary intervention (PCI) including stent thrombosis and restenosis. In patients with an acute coronary syndrome (ACS) the value of FFR is unclear as maximal hyperemia is required. In patients with an ACS microvascular changes may prevent vasodilatation thus affecting the validity of FFR. Studies have shown that FFR can be safely performed with high accuracy if performed a few days after an infarct.

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Usefulness of Fractional Flow Reserve Measurements to Defer Revascularization in Patients With Stable or Unstable Angina Pectoris, Non–ST-Elevation and ST-Elevation Acute Myocardial Infarction, or Atypical Chest Pain

Cited by 55 publications

References 28 publications

Clinical Outcome Following Conservative vs Revascularization Therapy in Patients With Stable Coronary Artery Disease and Borderline Fractional Flow Reserve Measurements

Clinical Outcome Following Conservative vs Revascularization Therapy in Patients With Stable Coronary Artery Disease and Borderline Fractional Flow Reserve Measurements

Correlation between coronary computed tomographic angiography and fractional flow reserve

Pressure Wire Assessment in Patients with An Acute Coronary Syndrome

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