Author + information
Although fractional flow reserve (FFR) value >0.8 can reliably identify lesions that are at a low risk of future coronary events, discrepancies between FFR values and results of other stress testing or severity of patients’ symptoms are occasionally encountered in daily practice. Percutaneous coronary interventions (PCI) can be performed in these FFR-determined functionally non-significant coronary lesions because of various clinical reasons. We aimed to clarify the prevalence and characteristics of PCI in FFR-determined functionally non-significant coronary lesions.
We retrospectively reviewed all patients who underwent coronary angiography and FFR measurement from January 2013 to September 2014. FFR value was obtained after intravenous adenosine infusion in all patients. A planned PCI was defined as PCI non-emergently performed within four weeks after the index coronary angiography. PCI in patients who failed initial medical management was not included as a planned PCI. The decision regarding revascularization was made at the discretion of the treating interventional cardiologist. Functionally non-significant lesion was defined as a lesion with FFR value >0.8. The reasons for interventions were carefully investigated by chart review including stress test results in the patients who underwent PCI in FFR-determined functionally non-significant coronary lesions.
Five hundred patients and 639 lesions were included in the analysis. Among 639 lesions, 129 lesions had FFR ≤0.8 and 510 lesions had FFR value >0.8. Of the 510 lesions with FFR >0.8, 32 lesions in 32 patients (6% of the lesions with FFR >0.8) were treated with either ad-hoc PCI (21 lesions) or planned PCI (11 lesions). Among the 32 lesions, 23 lesions were left anterior descending, 6 were circumflex and 3 were right coronary artery. FFR values were 0.81 in 8 lesions, 0.82 in 12 lesions, 0.83 in 5 lesions and 0.84 in 3 lesions. The reasons for revascularization in FFR-determined functionally non-significant lesions included CCS class 3-4 angina (n=15), abnormal stress testing (n=8), ulcerated plaque (n=2), wall motion abnormality (n=2), troponin elevation (n=1) and unknown (n=4).
Either ad-hoc or planned PCI was performed in 6% of the lesions with FFR value >0.8. Most common reasons for revascularization in FFR-determined functionally non-significant coronary lesions were severe angina and abnormal stress testing.