Global Fractional Flow Reserve Value Predicts 5-Year Outcomes in Patients With Coronary Atherosclerosis But Without Ischemia.

Abstract

Background Global fractional flow reserve (FFR) (ie, the sum of the FFR values in the 3 major coronary arteries) is a physiologic correlate of global atherosclerotic burden. The objective of the present study was to investigate the value of global FFR in predicting long-term clinical outcome of patients with stable coronary artery disease but no ischemia-inducing stenosis. Methods and Results We studied major adverse cardiovascular events (MACEs: all-cause death, myocardial infarction, and any revascularization) after 5 years in 1122 patients without significant stenosis (all FFR >0.80; n=275) or with at least 1 significant stenosis successfully treated by percutaneous coronary intervention (ie, post-percutaneous coronary intervention FFR >0.80; n=847). The patients were stratified into low, mid, or high tertiles of global FFR (≤2.80, 2.80-2.88, and ≥2.88). Patients in the lowest tertile of global FFR showed the highest 5-year MACE rate compared with those in the mid or high tertile of global FFR (27.5% versus 22.0% and 20.9%, respectively; log-rank P=0.040). The higher 5-year MACE rate was mainly driven by a higher rate of revascularization in the low global FFR group (16.4% versus 11.3% and 11.8%, respectively; log-rank P=0.038). In a multivariable model, an increase in global FFR of 0.1 unit was associated with a significant reduction in the rates of MACE (hazard ratio [HR], 0.988; 95% CI, 0.977-0.998; P=0.023), myocardial infarction (HR, 0.982; 95% CI, 0.966-0.998; P=0.032), and revascularization (HR, 0.985; 95% CI, 0.972-0.999; P=0.040). Conclusions Even in the absence of ischemia-producing stenoses, patients with a low global FFR, physiologic correlate of global atherosclerotic burden, present a higher risk of MACE at 5-year follow-up.

• Authors: Stephane Fournier, Carlos Collet, Panagiotis Xaplanteris, Frederik M Zimmermann, Gabor G Toth, Pim A L Tonino, Nico H J Pijls, Iginio Colaiori, Giuseppe Di Gioia, Emanuele Barbato, Peter Jüni, William F Fearon, Bernard De Bruyne
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 9 Issue 24 Pg. e017729 (12 15 2020) ISSN: 2047-9980 [Electronic] England
• PMID: 33283600 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Atherosclerosis (complications, pathology)
• Cardiovascular Diseases (epidemiology)
• Case-Control Studies
• Cause of Death (trends)
• Coronary Angiography (methods)
• Coronary Artery Disease (physiopathology, surgery)
• Coronary Vessels (diagnostic imaging, physiopathology)
• Cost of Illness
• Female
• Follow-Up Studies
• Fractional Flow Reserve, Myocardial (physiology)
• Humans
• Male
• Middle Aged
• Myocardial Infarction (epidemiology)
• Myocardial Revascularization (statistics & numerical data)
• Percutaneous Coronary Intervention (methods)
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Risk Assessment
• Time Factors