Usefulness of Fractional Flow Reserve during Routine Clinical Procedures in All-Comer Coronary Artery Disease Patients

摘要

Background: style="white-space:normal;font-family:;" "=""> Fractional flow reserve (FFR) style="white-space:normal;font-family:;" "="">- style="white-space:normal;font-family:;" "="">guided interventions style="white-space:normal;font-family:;" "="">, style="white-space:normal;font-family:;" "="">though proved to be safe, continue style="white-space:normal;font-family:;" "=""> style="white-space:normal;font-family:;" "="">to be a much-underutilized modality in determining treatment strategy, and data is lacking in Indian population. Objective: We aimed to determine the use of FFR-guided PCI and assess the overall impact on treatment decisions and clinical outcomes in patients with acute coronary syndrome (ACS) or chronic coronary syndromes (CCS). Methods: In this single-center retrospective and prospective observational study, FFR had been performed for the evaluation of treatment reclassification and clinical outcomes, as per physician’s clinical practice. Results: Data was obtained for 250 subjects (mean age 60.45 ± 9.6 years) with 324 lesions. The treatment plan based on angiography alone changed in 28% of lesions post-hyperemic FFR. The initial treatment plan based on angiography vs. the final treatment plan post-FFR (>0.80) was medical management 56.5% vs. 66.0%;CABG 11.1% vs. style="white-space:normal;font-family:;" "=""> style="white-space:normal;font-family:;" "="">7.7%;and PCI 32.4% vs style="white-space:normal;font-family:;" "="">. style="white-space:normal;font-family:;" "=""> 26.2%. In subjects initially assigned to medical management, 14% had changed to PCI, and for subjects initially assigned to PCI, 44% had changed to medical therapy. Receiver operating characteristics (ROC) curve analysis revealed a good correlation between a resting FFR value of <0.87 and hyperemic FFR value of <0.80. The rate of 2-year major adverse cardiovascular events (MACE) was 0.9%. Conclusion: This study supports the use of FFR in determining treatment strategy in ACS or CCS patients with low MACE. Resting FFR value of <0.87 may style="white-space:normal;font-family:;" "=""> style="white-space:normal;font-family:;" "="">be an alternative to intracoronary nitroglycerine/adenosine/Nikorandil-induced FFR in predicting positive FFR particularly in hemodynamically unstable patients, and who are intolerant to hyperemic drugs.