Abstract 20613: Fractional Flow Reserve in Acute Coronary Syndromes; Factors That Might Determine the Accurate Evaluation of the Non-Culprits
Objectives: To identify hemodynamic or other parameters which may affect the diagnostic accuracy of fractional flow reserve (FFR) measurements of the non-culprits in acute coronary syndromes.
Methods: We prospectively enrolled 101 patients with STEMI (n=75) submitted to primary PCI and NSTEMI (N=26) undergoing urgent PCI. FFR of 112 non-culprit stenoses was obtained immediately after PCI of the culprit and repeated 35±4 days later. Baseline characteristics, hemodynamic and angiographic parameters and biomarkers of myocardial necrosis/wall stress which correlated with FFR change between the follow-up and acute phase (ΔFFR), were entered in a multiple logistic regression model to identify independent predictors of ΔFFR. Using ROC curve analysis, we sought also at defining the cut-off values of the parameters associated with an absolute ΔFFR >0.04.
Results: Patients in the highest tertiles of left ventricular end-diastolic pressure (LVEDP) at baseline, had lower median ΔFFR (ΔFFR: −0.01, range −0.06 to +0.01 in the highest tertiles of LVEDP versus 0, range −0.01 to +0.03, in the mid tertiles versus 0, range −0.03 to +0.01, in the lowest tertiles, p=0.04). Large anterior wall infarctions, use of thrombus aspiration, IIbIIIa inhibitors and higher levels of troponin and PROBNP at baseline were not associated with ΔFFR. By multivariate analysis, there was a strong trend for LVEDP change to predict ΔFFR (B=0.3, p=0.052). LVEDP values higher than 27.5 mmHg could discriminate patients with an absolute ΔFFR > 0.04 (figure).
Conclusions: In the majority of the cases with an acute coronary syndrome, FFR can provide accurate evaluation of the hemodynamic severity of the non-culprits. Slight underestimation of the severity of the non-culprits might be anticipated in cases with significantly increased LVEDP in the acute phase.
- © 2010 by American Heart Association, Inc.