Author + information
- Hemal Bhatt,
- Sandeep Dayanand,
- Jasmin Martinez and
- Jon C. George
Coronary intervention is routinely deferred in intermediate coronary lesions with fractional flow reserve (FFR) ≥0.80. Recently, patients with borderline FFR (0.80-0.85) who were initially deferred have been shown to have higher risk of future interventions; however, the data are limited, and the long-term prognosis in these patients remains unknown. We assessed the utility of imaging guidance to determine the need for intervention in lesions with borderline FFR.
We retrospectively evaluated consecutive patients who underwent cardiac catheterization at Einstein Medical Center from January 2013 to April 2016. All patients with borderline FFR (0.80-0.85) were included. Patients were divided into Defer or Perform intervention groups. The Perform group was further stratified into intervention With or Without imaging guidance (i.e., intravascular ultrasound, optical coherence tomography, echocardiography, or pharmacologic stress test). The follow-up data were collected for all patients until April 2017, which included future target lesion revascularization (TLR) and major adverse cardiac events (MACE; cardiovascular mortality and acute coronary syndromes).
A total of 196 patients were eligible. The median (IQR) FFR in Perform and Defer groups was 0.81 (0.8-0.83) and 0.84 (0.82-0.85), respectively. The median (IQR) duration of follow-up was 21 (13-29) and 25 (15-36) months, respectively. The overall MACE rate in Perform group (n=101) was 8.9% (n=9) and Defer group (n=95) was 5.2% (n=5). The stratified MACE rate in With imaging guidance (n=57) was 7% (n=4) and Without imaging guidance (n=44) was 11.4% (n=5). Overall, the FFR-only guided management (n=196) led to MACE rate of 7.1% (n=14), whereas FFR With imaging guidance (n = 136) led to MACE rate of 6.6% (n=9). For reference, in the FAME study, MACE rate in FFR-guided cohort was 13.2% compared with angiography-guided cohort rate of 18.4%. The p-values were non-significant in each of the above group comparisons due to relatively low numbers with trends as noted.
Our study suggests that intervention of coronary lesions with borderline FFR under imaging guidance trends toward improved cardiovascular outcomes compared with intervention in this group without imaging. Overall, the use of imaging in borderline FFR lesions appears to help guide need for intervention for optimal outcomes. These findings need to be further validated in a large-scale prospective study.