Sergio Bravo Baptista1, Luís Raposo1, Lino Santos2, Ruben Ramos2, Rita Calé2, Elisabete Jorge2, Carina Machado2, Marco Costa2, Eduardo Infante de Oliveira2, João Costa2, João Pipa2, Nuno Fonseca2, Jorge Guardado2, Bruno Silva2, Maria-João Sousa2, João Carlos Silva2, Alberto Rodrigues2, Luís Seca2, Renato Fernandes2. 1. From the Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal (S.B.B.); Cardiology Department, Hospital Santa Cruz, CHLO, Carnaxide, Portugal (L.R.); Cardiology Department, Centro Hospitalar Vila Nova de Gaia, Portugal (L.S.); Cardiology Department, Hospital Santa Marta, Centro Hospitalar Lisboa Central, Portugal (R.R.); Cardiology Department, Hospital Garcia de Orta, Almada, Portugal (R.C.); Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Portugal (E.J.); Cardiology Department, Hospital Divino Espirito Santo, Ponta Delgada, Portugal (C.M.); Unidade de Intervenção Cardiovascular, Hospital Geral do Centro Hospitalar e Universitário de Coimbra, Portugal (M.C.); Cardiology Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Portugal (E.O.); Cardiology Department, Hospital de Braga, Portugal (J.C.); Cardiology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal (J.P.); Cardiology Department, Centro Hospitalar Setúbal, Portugal (N.F.); Cardiology Department, Hospital Santo André, Centro Hospitalar Leiria-Pombal, Portugal (J.G.); Cardiology Department, Hospital Dr. Nélio Mendonça, Funchal, Portugal (B.S.); Cardiology Department, Hospital Geral Santo António, Centro Hospitalar do Porto, Portugal (J.S.); Cardiology Department, Centro Hospitalar São João, Porto, Portugal (J.S.); Cardiology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal (A.R.); Cardiology Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Unidade Hospitalar Vila Real, Portugal (L.S.); and Cardiology Department, Hospital Espírito Santo, Évora, Portugal (R.F.). sergio.b.baptista@gmail.com lfor.md@gmail.com. 2. From the Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal (S.B.B.); Cardiology Department, Hospital Santa Cruz, CHLO, Carnaxide, Portugal (L.R.); Cardiology Department, Centro Hospitalar Vila Nova de Gaia, Portugal (L.S.); Cardiology Department, Hospital Santa Marta, Centro Hospitalar Lisboa Central, Portugal (R.R.); Cardiology Department, Hospital Garcia de Orta, Almada, Portugal (R.C.); Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Portugal (E.J.); Cardiology Department, Hospital Divino Espirito Santo, Ponta Delgada, Portugal (C.M.); Unidade de Intervenção Cardiovascular, Hospital Geral do Centro Hospitalar e Universitário de Coimbra, Portugal (M.C.); Cardiology Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Portugal (E.O.); Cardiology Department, Hospital de Braga, Portugal (J.C.); Cardiology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal (J.P.); Cardiology Department, Centro Hospitalar Setúbal, Portugal (N.F.); Cardiology Department, Hospital Santo André, Centro Hospitalar Leiria-Pombal, Portugal (J.G.); Cardiology Department, Hospital Dr. Nélio Mendonça, Funchal, Portugal (B.S.); Cardiology Department, Hospital Geral Santo António, Centro Hospitalar do Porto, Portugal (J.S.); Cardiology Department, Centro Hospitalar São João, Porto, Portugal (J.S.); Cardiology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal (A.R.); Cardiology Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Unidade Hospitalar Vila Real, Portugal (L.S.); and Cardiology Department, Hospital Espírito Santo, Évora, Portugal (R.F.).
Abstract
BACKGROUND: Penetration of fractional flow reserve (FFR) in clinical practice varies extensively, and the applicability of results from randomized trials is understudied. We describe the extent to which the information gained from routine FFR affects patient management strategy and clinical outcome. METHODS AND RESULTS: Nonselected patients undergoing coronary angiography, in which at least 1 lesion was interrogated by FFR, were prospectively enrolled in a multicenter registry. FFR-driven change in management strategy (medical therapy, revascularization, or additional stress imaging) was assessed per-lesion and per-patient, and the agreement between final and initial strategies was recorded. Cardiovascular death, myocardial infarction, or unplanned revascularization (MACE) at 1 year was recorded. A total of 1293 lesions were evaluated in 918 patients (mean FFR, 0.81±0.1). Management plan changed in 406 patients (44.2%) and 584 lesions (45.2%). One-year MACE was 6.9%; patients in whom all lesions were deferred had a lower MACE rate (5.3%) than those with at least 1 lesion revascularized (7.3%) or left untreated despite FFR≤0.80 (13.6%; log-rank P=0.014). At the lesion level, deferral of those with an FFR≤0.80 was associated with a 3.1-fold increase in the hazard of cardiovascular death/myocardial infarction/target lesion revascularization (P=0.012). Independent predictors of target lesion revascularization in the deferred lesions were proximal location of the lesion, B2/C type and FFR. CONCLUSIONS: Routine FFR assessment of coronary lesions safely changes management strategy in almost half of the cases. Also, it accurately identifies patients and lesions with a low likelihood of events, in which revascularization can be safely deferred, as opposed to those at high risk when ischemic lesions are left untreated, thus confirming results from randomized trials. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01835808.
BACKGROUND: Penetration of fractional flow reserve (FFR) in clinical practice varies extensively, and the applicability of results from randomized trials is understudied. We describe the extent to which the information gained from routine FFR affects patient management strategy and clinical outcome. METHODS AND RESULTS: Nonselected patients undergoing coronary angiography, in which at least 1 lesion was interrogated by FFR, were prospectively enrolled in a multicenter registry. FFR-driven change in management strategy (medical therapy, revascularization, or additional stress imaging) was assessed per-lesion and per-patient, and the agreement between final and initial strategies was recorded. Cardiovascular death, myocardial infarction, or unplanned revascularization (MACE) at 1 year was recorded. A total of 1293 lesions were evaluated in 918 patients (mean FFR, 0.81±0.1). Management plan changed in 406 patients (44.2%) and 584 lesions (45.2%). One-year MACE was 6.9%; patients in whom all lesions were deferred had a lower MACE rate (5.3%) than those with at least 1 lesion revascularized (7.3%) or left untreated despite FFR≤0.80 (13.6%; log-rank P=0.014). At the lesion level, deferral of those with an FFR≤0.80 was associated with a 3.1-fold increase in the hazard of cardiovascular death/myocardial infarction/target lesion revascularization (P=0.012). Independent predictors of target lesion revascularization in the deferred lesions were proximal location of the lesion, B2/C type and FFR. CONCLUSIONS: Routine FFR assessment of coronary lesions safely changes management strategy in almost half of the cases. Also, it accurately identifies patients and lesions with a low likelihood of events, in which revascularization can be safely deferred, as opposed to those at high risk when ischemic lesions are left untreated, thus confirming results from randomized trials. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01835808.
Authors: Ojas Hrakesh Mehta; Michael Hay; Ren Yik Lim; Abdul Rahman Ihdayhid; Michael Michail; Jun Michael Zhang; James D Cameron; Dennis T L Wong Journal: Cardiovasc Diagn Ther Date: 2020-06
Authors: Mariusz Tomaniak; Kaneshka Masdjedi; Tara Neleman; Ibrahim T Kucuk; Alise Vermaire; Laurens J C van Zandvoort; Nick Van Boven; Bas M van Dalen; Loe Kie Soei; Wijnand K den Dekker; Isabella Kardys; Jeroen M Wilschut; Roberto Diletti; Felix Zijlstra; Nicolas M Van Mieghem; Joost Daemen Journal: BMJ Open Date: 2022-04-04 Impact factor: 2.692