Key result
Functional revascularization using fractional flow reserve significantly reduced the average number of implanted stents per patient compared to angiography alone (1.4 vs 1.88, p=0.04) in patients with multilevel coronary lesions.
Why the study?
In borderline (>50-70%), multilevel coronary artery lesions, additional physiological assessment of each stenosis is needed beyond invasive coronary angiography to guide revascularization tactics.
Does functional revascularization using FFR reduce the number of implanted stents in patients with stable coronary artery disease and borderline multilevel lesions compared to angiography alone?
Observational (n=32)
No
Does functional revascularization using FFR reduce the number of implanted stents in patients with stable coronary artery disease and borderline multilevel lesions compared to angiography alone?
Absolute Event Rate: 1.4% vs 1.88%
p-value: p=0.04
Using FFR to guide revascularization in borderline multilevel coronary lesions safely reduces the number of implanted stents and the length of the stented segment compared to angiography alone.
Algorithm for FFR assessment in borderline CAD lesions is hypothesis-generating; prospective validation needed before clinical use.
When choosing tactics for the treatment of patients with stable coronary artery disease, invasive coronary angiography remains the gold standard for diagnosis and is a crucial method in choosing tactics and volume of revascularization. However, in the presence of borderline (>50-70%), multilevel lesions of the coronary artery, there is a need for additional assessment of the physiological significance of each stenosis. The aim. To develop an algorithm to optimize the use of fractional flow reserve (FFR) measurement in interventional treatment of borderline (>50-70%), multilevel lesions of coronary arteries, to show the safety of “functional revascula rization” in comparison with traditional angiography. Materials and methods. The study included 32 patients who were treated at the National Amosov Institute of Cardiovascular Surgery in the period from 2017 to 2021 (the vast majority were men – 25 patients (67%) and 7 (33%) women) aged 60.3±8.3 years who had >50-75% multilevel lesions of one of the main coronary arteries according to selective invasive coronary angiography. The patients were divided into two groups: 1) Angiographic group (n = 17, 53%), where the volume and tactics of revascularization were determined only by angiography (maximum complete anatomical revascularization); 2) Functional group (n=15, 47%) (combination of angiography data and FFR measurement, the so-called “functional revascularization”). Conclusions. An effective and safe algorithm for measuring FFR in multilevel lesions (reducing the number of implanted stents) is shown.
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Gavrylyshyn et al. (2021) conducted an observational in Stable ischemic heart disease with multilevel coronary artery lesions (n=32). Functional revascularization (Fractional Flow Reserve + angiography) vs. Angiography alone (anatomical revascularization) was evaluated on Average number of stents per patient (p=0.04). Functional revascularization using fractional flow reserve significantly reduced the average number of implanted stents per patient compared to angiography alone (1.4 vs 1.88, p=0.04) in patients with multilevel coronary lesions.
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