Yuhei Kobayashi1, Pim A L Tonino2, Bernard De Bruyne3, Hyoung-Mo Yang4, Hong-Seok Lim4, Nico H J Pijls2, William F Fearon5. 1. Stanford University Medical Center, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford, CA, USA. 2. Catharina Hospital, Eindhoven, the Netherlands. 3. Cardiovascular Center Aalst, Aalst, Belgium. 4. Stanford University Medical Center, Stanford, CA, USA; Ajou University School of Medicine, Suwon, Republic of Korea. 5. Stanford University Medical Center, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford, CA, USA. Electronic address: wfearon@stanford.edu.
Abstract
BACKGROUND:Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) significantly improves outcomes compared with angio-guided PCI in patients with multivessel coronary artery disease. However, there is a theoretical concern that in patients with reduced left ventricular ejection fraction (EF) FFR may be less accurate and FFR-guided PCI less beneficial. METHODS: From the FAME (Fractional flow reserve versus Angiography for Multivessel Evaluation) trial database, we compared FFR values between patients with reduced EF (both ≤ 40%, n = 90 and ≤ 50%, n = 252) and preserved EF (> 40%, n = 825 and > 50%, n = 663) according to the angiographic stenosis severity. We also compared differences in 1 year outcomes between FFR- vs. angio-guided PCI in patients with reduced and preserved EF. RESULTS: Both groups had similar FFR values in lesions with 50-70% stenosis (p = 0.49) and with 71-90% stenosis (p = 0.89). The reduced EF group had a higher mean FFR compared to the preserved EF group across lesions with 91-99% stenosis (0.55 vs. 0.50, p = 0.02), although the vast majority of FFR values remained ≤ 0.80. There was a similar reduction in the composite end point of death, nonfatal myocardial infarction, and repeat revascularization with FFR-guided compared to angio-guided PCI for both the reduced (14.5% vs. 19.0%, relative risk = 0.76, p = 0.34) and the preserved EF group (13.8 vs. 17.0%, relative risk = 0.81, p = 0.25). The results were similar with an EF cutoff of 40%. CONCLUSION: Reduced EF has no influence on the FFR value unless the stenosis is very tight, in which case a theoretically explainable, but clinically irrelevant overestimation might occur. As a result, FFR-guided PCI remains beneficial regardless of EF.
RCT Entities:
BACKGROUND: Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) significantly improves outcomes compared with angio-guided PCI in patients with multivessel coronary artery disease. However, there is a theoretical concern that in patients with reduced left ventricular ejection fraction (EF) FFR may be less accurate and FFR-guided PCI less beneficial. METHODS: From the FAME (Fractional flow reserve versus Angiography for Multivessel Evaluation) trial database, we compared FFR values between patients with reduced EF (both ≤ 40%, n = 90 and ≤ 50%, n = 252) and preserved EF (> 40%, n = 825 and > 50%, n = 663) according to the angiographic stenosis severity. We also compared differences in 1 year outcomes between FFR- vs. angio-guided PCI in patients with reduced and preserved EF. RESULTS: Both groups had similar FFR values in lesions with 50-70% stenosis (p = 0.49) and with 71-90% stenosis (p = 0.89). The reduced EF group had a higher mean FFR compared to the preserved EF group across lesions with 91-99% stenosis (0.55 vs. 0.50, p = 0.02), although the vast majority of FFR values remained ≤ 0.80. There was a similar reduction in the composite end point of death, nonfatal myocardial infarction, and repeat revascularization with FFR-guided compared to angio-guided PCI for both the reduced (14.5% vs. 19.0%, relative risk = 0.76, p = 0.34) and the preserved EF group (13.8 vs. 17.0%, relative risk = 0.81, p = 0.25). The results were similar with an EF cutoff of 40%. CONCLUSION: Reduced EF has no influence on the FFR value unless the stenosis is very tight, in which case a theoretically explainable, but clinically irrelevant overestimation might occur. As a result, FFR-guided PCI remains beneficial regardless of EF.
Authors: Tobias Härle; Mareike Luz; Sven Meyer; Felix Vahldiek; Pim van der Harst; Randy van Dijk; Daan Ties; Javier Escaned; Justin Davies; Albrecht Elsässer Journal: Clin Res Cardiol Date: 2017-11-02 Impact factor: 5.460
Authors: Hyun Sung Joh; Doosup Shin; Joo Myung Lee; Seung Hun Lee; David Hong; Ki Hong Choi; Doyeon Hwang; Coen K M Boerhout; Guus A de Waard; Ji-Hyun Jung; Hernan Mejia-Renteria; Masahiro Hoshino; Mauro Echavarria-Pinto; Martijn Meuwissen; Hitoshi Matsuo; Maribel Madera-Cambero; Ashkan Eftekhari; Mohamed A Effat; Tadashi Murai; Koen Marques; Joon-Hyung Doh; Evald H Christiansen; Rupak Banerjee; Hyun Kuk Kim; Chang-Wook Nam; Giampaolo Niccoli; Masafumi Nakayama; Nobuhiro Tanaka; Eun-Seok Shin; Steven A J Chamuleau; Niels van Royen; Paul Knaapen; Bon Kwon Koo; Tsunekazu Kakuta; Javier Escaned; Jan J Piek; Tim P van de Hoef Journal: J Am Heart Assoc Date: 2022-07-25 Impact factor: 6.106