Abstract 18216: Fractional Flow Reserve versus Coronary Pressure Reserve To Predict Major Cardiovascular Events In Patients With Equivocal Left Coronary Artery Stenosis
Objectives: Coronary pressure reserve (CPR), a new pressure wire-derived index of microcirculation and myocardial viability, was shown to predict major cardiovascular adverse events among patients with coronary artery disease. We evaluated the prognostic value of CPR and fractional flow reserve (FFR) on clinical outcome in patients with stable angina and equivocal left main (LMCA) and/or proximal left anterior descending artery (LAD) stenoses.
Methods: Patients with an intermediate stenosis in the LMCA and/or LAD and stable angina referred for elective coronary angiography (n=321) were consecutively recruited. FFR ≤0.8 were considered as a cut-off value for revascularization. CPR was calculated as the difference between baseline Pd/Pa and FFR multiplied by 100. CPR values lower than 15 were considered abnormal. Short- (one month) and long-term mortality (two years) rates as well as survival free of myocardial infarction and revascularization (MACE) by FFR, CPR or combined FFR-CPR subsets were the end-points of the study.
Results: According to FFR, 83 patients (26%) were treated invasively and all the others medically. Similar short-term mortality rates in both FFR treated and FFR deferred group (0% vs 0.8%, p=ns) and CPR<15 and CPR ≥15 subgroups were found (0.4 vs 0.2, p=ns). Long-term mortality was not different between FFR treated and FFR deferred (4.7% vs 4.7%, p=ns) and CPR<15 and CPR ≥15 subgroups (5% vs 4%, p=ns). In the FFR treated group, the short-term mortality was similar between patients with CPR<15 (0%) and CPR≥15 (0%, p=ns). Also the long-term mortality was similar by CPR subgroups (9.2% vs 2.3%, p=ns). Survival free of MACE was similar in both FFR ≤0.8 and FFR>0.8 subgroups (82.5 vs 82.8, p=ns) as well as in CPR<15 and CPR≥15 subgroups (83 vs 81.8, p=ns)
Conclusions: Negative FFR values predict a favorable outcome in patients with equivocal left coronary artery stenosis. CPR does not convey any additional prognostic information in these patients.
- © 2010 by American Heart Association, Inc.