Association of Lower Fractional Flow Reserve Values With Higher Risk of Adverse Cardiac Events for Lesions Deferred Revascularization Among Patients With Acute Coronary Syndrome
Key result
In acute coronary syndrome patients, every 0.01 decrease in fractional flow reserve for deferred lesions increased the risk of cardiovascular death, MI, or deferred lesion intervention (HR 1.08).
Why the study?
Does a lower FFR value (>0.80) increase the risk of adverse cardiac events in patients with ACS whose lesions are deferred for revascularization compared to non-ACS patients?
Population
674 patients with coronary lesions deferred revascularization based on fractional flow reserve values >0.80…
Comparison
Lower FFR values in patients with ACS vs Lower FFR values in patients with non-ACS
Design
Cohort
Follow-up
mean 4.5±2.1 years
Authors
Discussion
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Implication
May warrant closer monitoring in ACS with deferred low-FFR lesions; leaves open need for randomized outcome trials.
Study Design
Type
Observational (n=674)
Multicenter
No
Structured PICO
Does a lower FFR value (>0.80) increase the risk of adverse cardiac events in patients with ACS whose lesions are deferred for revascularization compared to non-ACS patients?
P
Population
674 patients with coronary lesions deferred revascularization based on FFR >0.80, including 334 with acute coronary syndrome, followed for a mean of 4.5 years.
E
Exposure
Lower FFR values (within the >0.80 range) in patients with ACS
C
Comparator
Lower FFR values (within the >0.80 range) in patients with non-ACS
O
Outcome
Composite of cardiovascular death, myocardial infarction (MI), or deferred lesion intervention (DLI)composite
Main Result
Hazard Ratio: 1.08 (95% CI 1.03–1.12)
p-value: p=<0.05
Lower FFR values (>0.80) in deferred lesions are associated with increased adverse cardiac events in ACS patients, but not in non-ACS patients, suggesting a need for caution when deferring revascularization based on FFR in the setting of ACS.
Limitations
- Retrospective, single-center observational design
- Possibility of reporting bias
- Absence of an independent clinical events committee
- Subjective determination of culprit versus nonculprit lesions
- Potential unmeasured confounders or selection bias
Cite This Study
Mehta et al. (2015) conducted an observational in Acute Coronary Syndrome (n=674). Lower fractional flow reserve (FFR) values vs. Higher FFR values was evaluated on Composite of cardiovascular death, myocardial infarction, or deferred lesion intervention (HR 1.08, 95% CI 1.03 to 1.12, p=<0.05). In acute coronary syndrome patients, every 0.01 decrease in fractional flow reserve for deferred lesions increased the risk of cardiovascular death, MI, or deferred lesion intervention (HR 1.08).