Abstract 10235: Fractional Flow Reserve and Long-Term Outcomes in Consecutive ‘Real-World’ Patients
Background: Coronary pressure-derived fractional flow reserve (FFR) is an invasive physiological index of the functional severity of coronary artery stenoses. Randomised trial data has demonstrated an FFR>0.80 predicts excellent clinical outcomes in medically managed patients. There is however limited information on how these trials translate to unselected ‘real-world’ clinical practice. Aim To determine the longer-term clinical outcome among consecutive patients with angiographic coronary artery disease (CAD) in whom coronary angiography demonstrated non flow-limiting stenoses (FFR>0.80) and who did not undergo percutaneous coronary intervention (PCI).
Method: Patients with symptomatic CAD undergoing coronary angiography with pressure-wire interrogation between January 2006 and May 2010 were identified. Clinical outcomes were assessed in patients with FFR>0.80 who did not undergo PCI and included presence of anginal chest pain, need for revascularization or death during a median follow-up of 17±9 months.
Results: 325 lesions were interrogated in 273 consecutive patients. FFR was >0.80 (mean 0.89 +/−0.05) in 190 patients (69.6%) and 228 lesions (83.5%). Co-morbidities included diabetes mellitus (15.8%) dyslipidiaemia (54.2%), hypertension (54.7%) and smoking (33.7%). Lesions were in the LAD in 52.9%, Circumflex in 24.6%, RCA in 15.8% and left main stem in 6.6%.Recurrence of angina was seen in 10.5% of patients with 5.8% reporting atypical chest pain. No myocardial infarction was noted. Revascularization was required in 6.3% with one cardiovascular death (0.5%) due to heart failure.
Conclusion: An FFR>0.80 in symptomatic patients with CAD predicts an excellent longer term mortality outcome with conservative management .Recurrent chest discomfort was noted in 1 in 6 patients however revascularisation was undertaken infrequently. This real world study confirms the utility of FFR in preventing unnecessary interventions in equivocal lesions.
- © 2010 by American Heart Association, Inc.