Abstract 10660: Is it Safe to Defer Revascularization of Coronary Lesions Without Inducible Myocardial Ischemia?
Background: Fractional flow reserve (FFR) is used to detect the presence of inducible myocardial ischemia. Deferral of revascularization for abnormal, but non-ischemic lesions is recommended; however, the long-term outcome of this approach is not known.
Methods: A PubMed search of the MEDLINE database identified studies that reported clinical outcomes among patients who had FFR-guided revascularization (percutaneous coronary intervention or coronary artery bypass grafting was left to operatory discretion). Inducible myocardial ischemia was defined as a FFR value below a pre-determined threshold (either 0.75 or 0.80 depending on the study). Baseline demographics and clinical outcome data were extracted by 2 independent reviewers. Random effects summary risk ratios were constructed using a DerSimonian-Laird model.
Results: From 628 potential studies, 16 were included in the meta-analysis (n = 2,868 participants). The mean FFR in the no-ischemia/deferral group was 0.88 versus 0.66 in the ischemia/revascularization group. At a mean follow-up of 29 months, the incidence of all-cause mortality was 3.7% in the no ischemia/deferral group versus 4.2% in the ischemia/revascularization group (RR=0.60, 95%CI 0.41-0.88, p = 0.009, I2=0%) (Figure). Outcomes were similar among patients with left main stenosis (RR=0.57, 95%CI 0.30-1.1, p = 0.094) versus non-left main stenosis (RR=0.63, 95%CI 0.40-1.00, p = 0.052). Myocardial infarction: 0.9% versus 3.0% (RR=0.57, 95%CI 0.28-1.17, p = 0.13, I2=0%), and revascularization: 5.9% versus 9.7% (RR=0.85, 95%CI 0.44-1.65, p = 0.63, I2=72.4%), respectively for no-ischemia/deferral versus ischemia/revascularization.
Conclusion: Deferral of revascularization for abnormal, but non-ischemic lesions was safe compared with revascularization of ischemic lesions. Future research will need to determine the optimal FFR threshold, above which revascularization can be deferred.
- © 2013 by American Heart Association, Inc.