Key result
FFR-guided deferral in reduced LVEF linked to ~35% lower 10-year mortality vs angiography alone.
Why the study?
Whether the favorable outcomes of FFR-guided revascularization deferral extend to patients with reduced left ventricular ejection fraction is unclear.
Does deferring revascularization based on FFR reduce all-cause death and MACCE in patients with reduced LVEF and intermediate coronary stenoses compared to angiography alone?
Cohort (n=840)
No
Does deferring revascularization based on FFR reduce all-cause death and MACCE in patients with reduced LVEF and intermediate coronary stenoses compared to angiography alone?
Hazard Ratio: 0.65 (95% CI 0.49–0.85)
Absolute Event Rate: 45.6% vs 57.8%
p-value: p=<0.01
In patients with reduced LVEF, deferring revascularization of intermediate coronary stenoses based on FFR rather than angiography alone is associated with improved long-term survival and lower MACCE rates.
May support FFR-guided deferral in reduced LVEF; extends prior data but requires randomized confirmation.
Background Deferring revascularization in patients with nonsignificant stenoses based on fractional flow reserve (FFR) is associated with favorable clinical outcomes up to 15 years. Whether this holds true in patients with reduced left ventricular ejection fraction is unclear. We aimed to investigate whether FFR provides adjunctive clinical benefit compared with coronary angiography in deferring revascularization of patients with intermediate coronary stenoses and reduced left ventricular ejection fraction. Methods and Results Consecutive patients with reduced left ventricular ejection fraction (≤50%) undergoing coronary angiography between 2002 and 2010 were screened. We included patients with at least 1 intermediate coronary stenosis (diameter stenosis ≥40%) in whom revascularization was deferred based either on angiography plus FFR (FFR guided) or angiography alone (angiography guided). The primary end point was the cumulative incidence of all‐cause death at 10 years. The secondary end point (incidence of major adverse cardiovascular and cerebrovascular events) was a composite of all‐cause death, myocardial infarction, any revascularization, and stroke. A total of 840 patients were included (206 in the FFR‐guided group and 634 in the angiography‐guided group). Median follow‐up was 7 years (interquartile range, 3.22–11.08 years). After 1:1 propensity‐score matching, baseline characteristics between the 2 groups were similar. All‐cause death was significantly lower in the FFR‐guided group compared with the angiography‐guided group (94 [45.6%] versus 119 [57.8%]; hazard ratio [HR], 0.65 [95% CI, 0.49–0.85]; P <0.01). The rate of major adverse cardiovascular and cerebrovascular events was lower in the FFR‐guided group (123 [59.7%] versus 139 [67.5%]; HR, 0.75 [95% CI, 0.59–0.95]; P =0.02). Conclusions In patients with reduced left ventricular ejection fraction, deferring revascularization of intermediate coronary stenoses based on FFR is associated with a lower incidence of death and major adverse cardiovascular and cerebrovascular events at 10 years.
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Gallinoro et al. (2022) conducted a cohort in Reduced left ventricular ejection fraction and intermediate coronary stenoses (n=840). Fractional flow reserve (FFR)-guided deferral of revascularization vs. Angiography-guided deferral of revascularization was evaluated on Cumulative incidence of all-cause death at 10 years (HR 0.65, 95% CI 0.49-0.85, p=<0.01). Deferring revascularization based on fractional flow reserve in patients with reduced left ventricular ejection fraction was associated with a significantly lower rate of all-cause death (HR 0.65) at 10 years compared with angiographic assessment alone.
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