Key result
ACS presentation linked to ~80% higher 2-year MACE risk vs CCS during FFRangio guidance.
Why the study?
Evidence on angiogram-based fractional flow reserve clinical outcomes remains limited compared with wire-based FFR, particularly in acute coronary syndromes.
Observational (n=2,245)
Yes
FFRangio-guided coronary intervention demonstrates favorable 2-year clinical outcomes in real-world practice, safely allowing deferral of lesions in both acute and chronic coronary syndromes.
ACS patients merit closer post-FFRangio surveillance; leaves open whether angiographic FFR refines risk stratification in acute versus chronic syndromes.
BACKGROUND: The use of angiogram-based fractional flow reserve technologies in routine clinical practice is increasing steadily. Available data suggest that it is associated with comparable clinical outcomes compared with wire-based fractional flow reserve (FFR), but evidence is still limited, especially in patients with acute coronary syndromes (ACSs). The aim of this study was to examine the real-world clinical outcomes of an angiogram based fractional flow reserve technology (FFRangio; CathWorks, Kfar-Saba, Israel) to guide treatment for coronary artery disease in patients presenting with acute versus chronic coronary syndromes (CCSs). METHODS: This is a retrospective, observational study. Our cohort included consecutive patients undergoing coronary angiography in 7 centers (Japan, 6; Israel, 1), whose treatment was guided by FFRangio between January 2021 and December 2023. The primary end point was 2-year cumulative incidence of major adverse cardiac events, stratified by presentation (ACS/CCS) and treatment strategy (revascularization/deferral). CONCLUSIONS: In a real-world setting, FFRangio-guided treatment yields 2-year outcomes comparable with current data for wire-based fractional flow reserve for both patients with ACS and patients with CCS. ACS presentation is associated with increased risk for major adverse cardiac events in patients undergoing FFRangio-guided revascularization but not deferral. These results demonstrate the clinical utility of FFRangio-guided treatment across the spectrum of coronary artery disease presentation excluding ST-segment-elevation myocardial infarction. REGISTRATION: URL: https://clinicaltrials.gov/study/NCT05648396?term=FFRangio%20&viewType=Card&rank=3; Unique Identifier: NCT05648396.
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Witberg et al. (2026) conducted an observational in Coronary Artery Disease (n=2,245). Acute Coronary Syndrome (ACS) presentation vs. Chronic Coronary Syndrome (CCS) presentation was evaluated on Major adverse cardiac events (composite of all-cause death, MI, and any repeat revascularization) at 2 years (adjusted HR 1.80, 95% CI 1.31-2.46, p=<0.001). In patients undergoing FFRangio-guided treatment, acute coronary syndrome presentation was associated with a higher 2-year risk of major adverse cardiac events compared to chronic coronary syndromes (adjusted HR 1.80).
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