What is the clinical evidence from this study?

Study design: Cohort. Population: Cancer and stable coronary artery disease (n=57). Intervention: Stent placement guided by FFR assessment vs. No stent placement (medical therapy). Primary outcome: All-cause death (HR 0.37, 95% CI 0.15-0.90, p=0.03).

What does this research mean for the field?

In cancer patients with stable coronary artery disease, receiving a stent guided by fractional flow reserve assessment is associated with a significantly reduced risk of all-cause mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the specific management, safety, and clinical outcomes of fractional flow reserve-guided percutaneous coronary intervention in cancer patients presenting with stable coronary artery disease.

August 4, 2026MedicinaOpen Access

Reclassification of Treatment Strategy with Fractional Flow Reserve in Cancer Patients with Coronary Artery Disease

Q: What are the key findings of this study?

Receiving a stent guided by fractional flow reserve assessment was significantly associated with a decreased risk of all-cause death (HR 0.37) in cancer patients with stable coronary artery disease.

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Key result

FFR-guided stenting linked to ~63% lower mortality in cancer patients with stable CAD.

HR 0.37
95% CI 0.15-0.90
P=0.03
n=57

Why the study?

Cancer and CAD often coexist, and FFR is more reliable than QCA for identifying significant stenoses, but the management, safety, and outcomes of FFR-guided PCI in cancer patients with stable CAD needed assessment.

Does an FFR-guided PCI strategy using a ≤0.75 threshold improve survival and reduce complications in cancer patients with stable CAD?

Key Points

To evaluate the specific management, safety, and clinical outcomes of fractional flow reserve-guided percutaneous coronary intervention in cancer patients presenting with stable coronary artery disease.
Assessed 57 cancer patients with stable coronary artery disease and ≥50% stenosis by quantitative coronary angiography who underwent fractional flow reserve (FFR) evaluation between September 2008 and May 2016.
Revascularized lesions with FFR ≤ 0.75 using percutaneous coronary intervention and dual antiplatelet therapy, whereas lesions with FFR > 0.75 were deferred to optimal medical therapy alone.
Tracked periprocedural complications, urgent revascularizations, acute coronary syndromes, and all-cause mortality over a median follow-up of 43 months (95% CI 31–53 months).
FFR reclassified 14 of 31 lesions (45.1%) with ≥70% stenosis on angiography as moderate (FFR ≥ 0.75), avoiding stenting and dual antiplatelet therapy, while 6 of 26 lesions (23%) with <70% stenosis were reclassified as severe (FFR < 0.75) and treated with stenting.
Zero periprocedural complications, urgent revascularizations, acute coronary syndromes, or cardiovascular deaths occurred, though 1-year mortality was 22.8% (all cancer-related) and overall follow-up mortality reached 22 patients (38.6%).
Patients receiving an FFR-indicated stent experienced a significant reduction in the risk of all-cause mortality compared to those managed medically (HR: 0.37, 95% CI 0.15−0.90, p = 0.03).

Study Design

Type

Cohort (n=57)

Multicenter

Structured PICO

Does an FFR-guided PCI strategy using a ≤0.75 threshold improve survival and reduce complications in cancer patients with stable CAD?

Population

57 cancer patients with symptomatic stable coronary artery disease and a life expectancy of at least 6 months who underwent FFR assessment, followed for a median of 43 months.

Exposure

Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) with bare-metal or drug-eluting stents and dual antiplatelet therapy (DAPT) for lesions with FFR ≤ 0.75.

Comparator

Optimal medical management (OMT) alone for lesions with FFR > 0.75.

Outcome

Procedure-related complications (bleeding, coronary dissection or perforation, and renal insufficiency) and major adverse cardiovascular events (MACE), defined as myocardial infarction, heart failure, percutaneous cardiac intervention, coronary artery bypass grafting, cardiac death, and overall mortality.composite

Main Result

Hazard Ratio: 0.37 (95% CI 0.15–0.9)

p-value: p=0.03

In cancer patients with stable CAD, an FFR-guided PCI strategy using a ≤0.75 threshold safely avoids unnecessary revascularization and is associated with reduced all-cause mortality in stented patients.

Limitations

Retrospective design
Small sample size
Heterogeneity of noninvasive imaging data and initial work-up
Non-randomized
Not randomized

Implication

Hypothesis-generating for FFR-guided PCI in cancer patients with stable CAD; requires randomized confirmation before practice change.

Abstract

Background and Objectives: Cancer and coronary artery disease (CAD) often coexist. Compared to quantitative coronary angiography (QCA), fractional flow reserve (FFR) has emerged as a more reliable method of identifying significant coronary stenoses. We aimed to assess the specific management, safety and outcomes of FFR-guided percutaneous coronary intervention (PCI) in cancer patients with stable CAD. Materials and Methods: FFR was used to assess cancer patients that underwent coronary angiography for stable CAD between September 2008 and May 2016, and were found to have ≥50% stenosis by QCA. Patients with lesions with an FFR > 0.75 received medical therapy alone, while those with FFR ≤ 0.75 were revascularized. Procedure-related complications, all-cause mortality, nonfatal myocardial infarction, or urgent revascularizations were analyzed. Results: Fifty-seven patients with stable CAD underwent FFR on 57 lesions. Out of 31 patients with ≥70% stenosis as measured by QCA, 14 (45.1%) had an FFR ≥ 0.75 and lesions were reclassified as moderate and did not receive PCI nor DAPT. Out of 26 patients with <70% stenosis as measured by QCA, 6 (23%) had an FFR < 0.75 and were reclassified as severe and were treated with PCI and associated DAPT. No periprocedural complications, urgent revascularization, acute coronary syndromes, or cardiovascular deaths were noted. There was a 22.8% mortality at 1 year, all cancer related. Patients who received a stent by FFR assessment showed a significant association with decreased risk of all-cause death (HR: 0.37, 95% CI 0.15−0.90, p = 0.03). Conclusions: Further studies are needed to define the optimal therapeutic approach for cancer patients with CAD. Using an FFR cut-off point of 0.75 to guide PCI translates into fewer interventions and can facilitate cancer care. There was an overall reduction in mortality in patients that received a stent, suggesting increased resilience to cancer therapy and progression.

Discussion

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Published by Medicina · CC BY

Cite This Study

Kim et al. (2022) conducted a cohort in Cancer and stable coronary artery disease (n=57). Stent placement guided by FFR assessment vs. No stent placement (medical therapy) was evaluated on All-cause death (HR 0.37, 95% CI 0.15-0.90, p=0.03). Receiving a stent guided by fractional flow reserve assessment was significantly associated with a decreased risk of all-cause death (HR 0.37) in cancer patients with stable coronary artery disease.

synapsesocial.com/papers/6a7164ebfe4101aa97e08e73 https://doi.org/10.3390/medicina58070884

Topics

Coronary artery disease

Percutaneous coronary intervention

Dual antiplatelet therapy

Cardio-oncology

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Implication

Hypothesis-generating for FFR-guided PCI in cancer patients with stable CAD; requires randomized confirmation before practice change.

Reclassification of Treatment Strategy with Fractional Flow Reserve in Cancer Patients with Coronary Artery Disease

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Topics

Reclassification of Treatment Strategy with Fractional Flow Reserve in Cancer Patients with Coronary Artery Disease

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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