Abstract 12106: Long-Term Clinical Outcome in Patients with Angiographically Intermediate Lesion of the Coronary Artery By-Pass Graft Deferred on the Basis of Fractional Flow Reserve Measurement
Purpose. An intermediate stenosis of a native coronary artery can be safely deferred on the basis of non-significant Fractional Flow Reserve (FFR). In addition, deferring a left main stenosis with FFR>0.80 is safe and it has been associated with an outcome comparable to that of functionally significant left main lesion but undergoing revascularization. It is still unknown whether deferring intermediate stenosis of coronary artery by-pass graft (CABG) is safe on the basis of FFR measurement.
Methods. We included 58 CABG patients (pts) referred for coronary angiography and FFR measurement of intermediate stenosis involving an arterial or venous graft. Pts were divided into 2 groups: FFR positive (FFR pos < 0.80) and FFR negative (FFR neg > 0.80). Clinical endpoints were assessed at the follow-up: death, acute coronary syndrome (ACS), recurrent angina, target vessel revascularization (TVR).
Results. FFR was < 0.80 in 16 pts, while FFR was > 0.80 in 42 pts (0.71+0.09 vs. 0.92+0.05, respectively, p<0.001). FFR was more frequently positive in arterial grafts as compared with saphenous vein grafts (57% vs. 11%, p = 0,009). Baseline clinical characteristics were comparable in both groups. Angiographic metrics in FFR pos and FFR neg group were as follows: % diameter stenosis (%DS, 54+12% vs 37+17%, p<0.01); minimal lumen diameter (MLD, 1.39+0.41 vs 1.74+0.78, p=0.09); reference diameter (RD, 2.71+0.75 vs 2.83+0.91, p=0.65). In the FFR pos group, PCI was performed in 16 pts (100 %). In the FFR neg group, despite negative functional assessment, PCI was performed in 3 pts. At a median follow-up of 48 months (19-75), no difference was observed between the 2 groups in terms of death [3 (19%) vs. 10 (24%), p=0.89], TVR [1 (6.3%) vs. 3 (7.1%), p=1], recurrent angina [9 (69%) vs. 12 (38%), p=0.19], ACS (3 [23%] vs. 3 [6%], p = 0.59).
Conclusions. Deferral of intermediate lesions of coronary artery by-pass graft following FFR measurement is safe as it is associated with long-term clinical outcome which is comparable yet slightly better than that observed in patients undergoing PCI for functionally significant lesions. Moreover, our data suggest that angiography tends to underestimate the severity of lesions involving both arterial and vein grafts.
- Coronary heart disease
- Interventional cardiology
- Percutaneous coronary intervention
- Aortocoronary bypass
- © 2011 by American Heart Association, Inc.