Key result
In patients with deferred revascularization for intermediate coronary lesions, lower FFR values (0.81-0.85) independently predicted deferred target lesion failure (HR 2.79).
Why the study?
While deferring intermediate lesions based on FFR is safe, lesions near the >0.80 cut-off may have less favorable outcomes, prompting evaluation of long-term outcomes and predictors of deferred target lesion failure.
Cohort (n=600)
Yes
Hazard Ratio: 2.79 (95% CI 1.46–5.32)
p-value: p=0.002
While deferring revascularization for lesions with FFR >0.80 is generally safe, FFR values closer to the ischemic threshold (0.81-0.85), multivessel disease, distal lesions, and saphenous vein graft lesions are associated with higher rates of target lesion failure.
OBJECTIVES: The aim was to assess long-term outcome after deferring intervention of coronary lesions with a fractional flow reserve (FFR) value of >0.80 in a real-world patient population and then to identify factors associated with deferred target lesion failure (DTLF). BACKGROUND: Deferring coronary interventions of intermediate lesions based on FFR measurement is safe, irrespective of the extent of coronary artery disease. However, FFR values near the cut-off of >0.80 may have less favorable outcome. METHODS: A retrospective analysis was performed in patients with deferred coronary intervention based on FFR value >0.80. The primary endpoint was DTLF, a composite of acute coronary syndrome (ACS) and any coronary revascularization, related to the initially deferred stenosis. RESULTS: A total of 600 patients, mean age of 66 ± 10 years, and 751 coronary lesions with negative FFR values (mean 0.88 ± 0.04) were included. The mean follow-up was 27 ± 15 months. DTLF occurred in 44 patients (7.3%), revascularization in 42 (7%), and ACS without revascularization in 2 patients (0.3%). Patients with DTLF more often had diabetes mellitus, previous coronary artery bypass grafting, multivessel disease (MVD), and lower FFR at inclusion. Multivariable regression analysis showed that lower deferred FFR values [FFR 0.81-0.85: hazard ratio (HR) 2.79 (95% CI [confidence interval]; 1.46-5.32), p .002], MVD [HR 1.98 (95% CI; 1.05-3.75), p .036], distal lesions [HR 2.43 (95% CI; 1.29-4.57), p .006], and lesions located in a saphenous vein graft (SVG) [HR 6.35 (95% CI; 1.81-22.28), p .004] were independent predictors for DTLF. CONCLUSIONS: The long-term rate of DTLF of initially deferred coronary lesions was 7.3%. Independent predictors for DTLF are lower deferred FFR value, the presence of MVD, distal lesions, and lesions in SVG.
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Weerts et al. (2020) conducted a cohort in Intermediate coronary lesions (n=600). Lower deferred FFR values (0.81-0.85) vs. FFR value >0.85 was evaluated on Deferred target lesion failure (DTLF), a composite of acute coronary syndrome (ACS) and any coronary revascularization related to the initially deferred stenosis (HR 2.79, 95% CI 1.46-5.32, p=0.002). In patients with deferred revascularization for intermediate coronary lesions, lower FFR values (0.81-0.85) independently predicted deferred target lesion failure (HR 2.79).
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