Prognostic impact of FFR/contrast FFR discordance. (15th March 2021)

• Record Type: Journal Article
• Authors: Leone, Antonio Maria; Arioti, Manfredi; Cialdella, Pio; Vergallo, Rocco; Zimbardo, Giuseppe; Migliaro, Stefano; Anastasia, Gianluca; Di Giusto, Federico; Galante, Domenico; Basile, Eloisa; Pepe, Francesca Lassandro; Ierardi, Carolina; D'Amario, Domenico; Burzotta, Francesco; Aurigemma, Cristina; Niccoli, Giampaolo; Trani, Carlo; Crea, Filippo
• Is Part Of: International journal of cardiology. Volume 327(2021)
• Page Start: 40
• Page End: 44
• Publication Date: 2021-03-15
• Subjects: Fractional flow reserve -- Percutaneous coronary intervention -- Contrast -- Physiological evaluation -- Personalized medicine; ACS acute coronary syndrome -- CAD coronary artery disease -- cFFR contrast fractional flow reserve -- FFR fractional flow reserve -- iFR instantaneous wave-free ratio -- LAD left anterior descending -- LCx left circumflex -- MACE major adverse cardiovascular events -- MI myocardial infarction -- PCI percutaneous coronary intervention -- RCA right coronary artery -- SD standard deviation -- SIHD stable ischemic heart disease -- TVR target vessel revascularization; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.11.011
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Contrast fractional flow reserve (cFFR) is a relatively new tool for the assessment of intermediate coronary artery stenosis and represents a reliable surrogate of FFR with the advantage of potentially simplifying functional evaluation. We aimed to compare the incidence of major adverse cardiac events (MACE) in patients undergoing functional evaluation with both FFR and cFFR based on the results of the two indexes. Method and Result: We retrospectively analyzed outcomes in 488 patients who underwent functional evaluation with FFR and cFFR. Patients were divided into four groups using the cutoff values of 0.80 for FFR and 0.85 for cFFR: −/− (n = 298), +/+ (n = 134), −/+(n = 31) and +/− (n = 25). All patients were treated according to FFR value. MACE rate was assessed in each group, including death, myocardial infarction and urgent target vessel revascularization (TVR). Mean follow-up time was 22 ± 15 months. Incidence of MACE at follow-up was 8.3% in FFR−/cFFR−, 14.0% in FFR+/cFFR+, 16.0% in FFR−/cFFR+ and 8.0% in FFR+/cFFR− without a significant difference amongst the 4 groups (p = 0.2). Nevertheless, a significant difference in the rate of TVR comparing FFR−/cFFR− (n = 17) and FFR−/cFFR+ (n = 5) was found at 24 months (5.7% vs 16.0%; p = 0.027). Conclusion: cFFR is accurate in predicting FFR and consequently reliable in guiding coronary revascularization. In the rare case of discordance, while FFR+/cFFR- patients show a prognosis similar to FFR-/cFFR- patients, FFR-/cFFR+ patients show a prognosis similar to FFR+/cFFR+ patients. Highlights: cFFR is a new tool in the assessment of intermediate coronary stenosis. cFFR is accurate in predicting FFR and reliable in guiding revascularization. In case of discordance, no significant difference in outcome choosing cFFR. In patients with FFR > 0.80 and cFFR ≤ 0.85 TVR is higher. cFFR could be a more sensitive index.