FFR-angio was comparable to NHPRs for assessing ischemia in patients with aortic stenosis, with no significant difference in 1-year MACE (3.4% vs. 3.2%; p=0.43).
Cohort (n=356)
No
Does FFR-angio compared to NHPRs improve 1-year MACE in patients with intermediate coronary artery stenosis and aortic stenosis?
In patients with aortic stenosis and intermediate coronary lesions, FFR-angio is comparable to wire-based NHPRs for assessing ischemia regarding 1-year MACE, while significantly reducing radiation exposure and contrast volume.
Absolute Event Rate: 3.4% vs 3.2%
p-value: p=0.43
Abstract Background Several studies have reported on the use of wire-based functional flow reserve (FFR) and non-hyperemic pressure ratios (NHPRs) in patients with aortic valve stenosis (AS). Angio-based FFR is a wire-free method for assessing coronary ischemia; however, its effectiveness in patients with AS remains unclear. Purpose We evaluated the utility of FFR-angio compared to NHPRs in patients with AS. Methods This was a single-center, retrospective study. The primary endpoint was the 1-year major adverse cardiac events (MACE), defined as the composite of cardiovascular death, myocardial infarction, and target lesion revascularization. AS was defined as moderate or severe AS detected by transthoracic echocardiography. FFR-angio was used as an angio-based FFR with a cutoff value set at 0.80. NHPRs were defined as the instantaneous wave-free ratio, resting full-cycle ratio, and diastolic hyperemia-free ratio, with cutoff values set at 0.89. The final treatment strategy was determined by a heart team conference, taking into account lesion characteristics and patient background. Results The study included 356 patients with intermediate coronary artery stenosis (as identified by coronary angiography) and AS between June 1, 2022, and December 31, 2023. The mean age was 82.5 years. The number of patients in each coronary revascularization treatment strategy was as follows: percutaneous coronary intervention - 107 (30.0%), coronary artery bypass grafting - 49 (13.8%), and deferred treatment - 200 (56.2%). The number of patients in each aortic valve treatment strategy were as follows: transcatheter aortic valve implantation - 261 (73.3%), surgical aortic valve replacement - 68 (19.1%), and follow-up - 27 (7.6%) Based on operator judgment, patients underwent either FFR-angio (n = 129) or NHPRs (n = 227) for ischemia assessment. There was no significant difference in the 1-year cumulative incidence of MACE between the FFR-angio and NHPRs groups (3.4% vs. 3.2%, respectively; p = 0.43, Figure1). However, radiation exposure and contrast medium volume were significantly lower in the FFR-angio group compared with the NHPRs group (radiation: 288.5 ± 175.7 mGy vs. 511.2 ± 297.2 mGy, p 0.01; contrast: 58.0 ± 20.7 mL vs. 71.6 ± 25.0 mL, p 0.01, Figure2). Conclusion FFR-angio is comparable to NHPRs for assessing ischemia in patients with AS and is less invasive. However, the optimal cutoff values for NHPRs and FFR-angio in patients with AS remain unclear, and whether treatment decisions based on the existing cutoffs are appropriate remains controversial. Prospective studies are needed to determine the optimal cutoff for FFR-angio in patients with AS.
Inaba et al. (Sat,) conducted a cohort in Aortic stenosis and intermediate coronary artery stenosis (n=356). FFR-angio vs. NHPRs (non-hyperemic pressure ratios) was evaluated on 1-year major adverse cardiac events (MACE), defined as the composite of cardiovascular death, myocardial infarction, and target lesion revascularization (p=0.43). FFR-angio was comparable to NHPRs for assessing ischemia in patients with aortic stenosis, with no significant difference in 1-year MACE (3.4% vs. 3.2%; p=0.43).