Fractional Flow Reserve-Guided Strategy in Acute Coronary Syndrome. A Systematic
            Review and Meta-Analysis

Angiography is inaccurate in assessing functional significance of coronary lesions, and often stenoses deemed severe on angiographic assessment do not restrict coronary blood flow at rest or with maximal dilatation. Angiography-guided revascularization has not shown improvement in hard clinical outcomes in stable ischemic heart disease (SIHD). Most current guidelines for SIHD recommend invasive functional assessment of lesions to guide revascularization if prior evidence of ischemia is not available. There has been several recent advances and development of novel methods in this arena. Various contemporary clinical trials have been undertaken for validation of these indices. Here we review the physiological basis, tools, techniques, and evidence base for various invasive (resting as well as hyperemic) and noninvasive methods for functional assessment of coronary lesions. Left main stenosis, bifurcation lesions, serial stenosis, and acute coronary syndrome each causes unique disequilibrium that may affect measurements and require special considerations for accurate functional assessment.

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“…The results from this analysis demonstrated higher risk of MI but not of other MACE components in ACS patients. 21…”

Section: Special Scenarios Acute Coronary Syndromementioning

confidence: 99%

Functional Assessment of Coronary Artery Lesions—Old and New Kids on the Block

et al. 2021

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“…The use of FFR-guided revascularization in acute coronary syndrome (ACS) has a lesser prognostic value compared to stable angina. 25 The reason for this and the more emergent need for revascularization in ACS is the significantly increased incidence of MACE in spite of following a strategy of ACS revascularization determined by FFR. 26 Deferral of revascularization in the case of stable angina, as supported by FFR, does not appear to be as safe in the case of a patient with ACS due to the much higher incidence of MACE.…”

Section: Acute Coronary Syndromementioning

confidence: 99%

Use and Value of Fractional Flow Reserve in Coronary Arteriography

2019

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“…Different independent risk factors for recurrent ischemic events for negative FFR results have been identified in previous studies, which differ from solely FFR values, 20 to also ACS indication, 18,23,24 multivessel coronary artery disease (MVD), 18,24 previous ischemic events, 18 proximal lesion location, 21 and diabetes mellitus (DM) 25,26 . However, the question remains which risk factors truly contribute to less favorable outcome in patients with deferred revascularization due to a negative FFR.…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcome after deferred revascularization due to negative fractional flow reserve in intermediate coronary lesions

Weerts

Pustjens

Amin

et al. 2020

Cathet Cardio Intervent

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Objectives The aim was to assess long‐term outcome after deferring intervention of coronary lesions with a fractional flow reserve (FFR) value of >0.80 in a real‐world patient population and then to identify factors associated with deferred target lesion failure (DTLF). Background Deferring coronary interventions of intermediate lesions based on FFR measurement is safe, irrespective of the extent of coronary artery disease. However, FFR values near the cut‐off of >0.80 may have less favorable outcome. Methods A retrospective analysis was performed in patients with deferred coronary intervention based on FFR value >0.80. The primary endpoint was DTLF, a composite of acute coronary syndrome (ACS) and any coronary revascularization, related to the initially deferred stenosis. Results A total of 600 patients, mean age of 66 ± 10 years, and 751 coronary lesions with negative FFR values (mean 0.88 ± 0.04) were included. The mean follow‐up was 27 ± 15 months. DTLF occurred in 44 patients (7.3%), revascularization in 42 (7%), and ACS without revascularization in 2 patients (0.3%). Patients with DTLF more often had diabetes mellitus, previous coronary artery bypass grafting, multivessel disease (MVD), and lower FFR at inclusion. Multivariable regression analysis showed that lower deferred FFR values [FFR 0.81–0.85: hazard ratio (HR) 2.79 (95% CI [confidence interval]; 1.46–5.32), p .002], MVD [HR 1.98 (95% CI; 1.05–3.75), p .036], distal lesions [HR 2.43 (95% CI; 1.29–4.57), p .006], and lesions located in a saphenous vein graft (SVG) [HR 6.35 (95% CI; 1.81–22.28), p .004] were independent predictors for DTLF. Conclusions The long‐term rate of DTLF of initially deferred coronary lesions was 7.3%. Independent predictors for DTLF are lower deferred FFR value, the presence of MVD, distal lesions, and lesions in SVG.

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Fractional Flow Reserve-Guided Strategy in Acute Coronary Syndrome. A Systematic Review and Meta-Analysis

Cited by 7 publications

References 45 publications

Functional Assessment of Coronary Artery Lesions—Old and New Kids on the Block

Functional Assessment of Coronary Artery Lesions—Old and New Kids on the Block

Use and Value of Fractional Flow Reserve in Coronary Arteriography

Long‐term outcome after deferred revascularization due to negative fractional flow reserve in intermediate coronary lesions

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