Impact of fractional flow reserve on decision-making in daily clinical practice: A single center experience in Egypt

ElFaramawy, Amr; Hassan, Mohammad L.; Nagy, Michael W.; ElGuindy, Ahmed; Elmahdy, Mahmoud Farouk

doi:10.1016/j.ehj.2017.12.007

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…This present research revealed that the lesion length and stenosis severity predicted lower FFR. FFR calculation is therefore sufficient to classify intermediate LM stenosis patients in whom excellent results can be associated with revascularization postpone, and this is in accordance with Elfaramawy et al (12) .…”

Section: Discussionsupporting

confidence: 86%

Evaluating the Impact of Fractional Flow Reserve (FFR) on Decision-Making for Treatment of Borderline Coronary Artery Lesions:

El‐Barbary¹,

Kazamel²,

Tamara³

2021

The Egyptian Journal of Hospital Medicine

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Background: The primary reference criterion for evaluating coronary artery stenosis functional significance is fractional flow reserve (FFR). It helps the interventionist to define appropriate angiographic borderline coronary lesions that should or should not be treated with a stent. Objective: To evaluate the experience of the cardiology department, MUST University, on the use of FFR and its impact on patients with a borderline coronary lesion as regard revascularization decision-making. Patients and methods: A retrospective study were done on 86 patients with borderline lesions undergoing coronary angiograms for whom FFR was performed. Three experienced cardiac interventionists re-analyzed their coronary angiography and whether to delay or conduct revascularization with borderline stenotic lesions (40-70 %). A distinction was made between the findings of quantitative coronary angiography (QCA), visual and functional assessment of coronary stenosis severity. Result: Eighty-six patients (51 males and 35 females) with a mean age of 58.60 ± 9.20 were enrolled in the current study. FFR was < 0.80 in 26.74% (23/86) of the patients, and they had coronary angioplasty. Between quantitative evaluation of lesion diameter by FFR and visual measurement, the correlation was -0.645 (P < 0.001). Seven patients (8.139%) had FFR > 0.8 left main (LM) lesion and for the other vessels with severe coronary lesions, stenting was performed. Conclusion:In patients having borderline coronary artery stenosis, FFR is an important tool for clinical decisions making about procedures of revascularization. FFR results in alteration in the coronary intervention judgment.

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Section: Discussionsupporting

confidence: 86%

Evaluating the Impact of Fractional Flow Reserve (FFR) on Decision-Making for Treatment of Borderline Coronary Artery Lesions:

El‐Barbary¹,

Kazamel²,

Tamara³

2021

The Egyptian Journal of Hospital Medicine

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“…However, FFR remains the gold standard for the evaluation of the functional relevance of coronary artery stenosis. 28,29 In a group of STEMI patients with multivessel disease, revascularized with culprit-only PCI, FFR measured in the non-culprit lesions immediately after successful primary PCI showed a nonlinear and inverse risk continuum of MACE. 30,31,34,35…”

Section: Discussionmentioning

confidence: 99%

Management of Culprit and Non-Culprit Lesions in Acute Coronary Syndrome

Gerculy¹,

Mitra²,

Szabó³

et al. 2021

Journal of Interdisciplinary Medicine

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Multivessel coronary artery disease, defined by the presence of a significant stenosis (≥50% diameter) in two or more epicardial coronary vessels, usually occurs in more than 50% of patients with ST-segment elevation myocardial infarction. The latest guidelines indicate revascularization of the non-culprit artery with a recommendation of class IIB. However, the management of non-culprit lesions in patients with acute coronary syndrome is still a matter of debate. This article presents the most recent concepts related to the management of culprit and non-culprit coronary lesions, based on advanced imaging approaches, in order to identify high-risk patients and prevent further acute coronary syndromes.

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Unstable Angina Pectoris or Unstable Coronary Syndromes?

Mitkovskaya¹,

Laskina²,

Teefy³

2020

Emerg Cardiol Cardiovasc Risk

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Unstable angina pectoris (UA) is a variant of acute coronary syndrome without ST segment elevation (NSTEACS), which is characterized by the absence of biochemical criteria for myocardial damage, a change in the clinical picture of angina pectoris (an increase in the functional class of angina pectoris, the appearance of resting angina and a high probability of transformation of the process into myocardial infarction (MI). UA and the developed MI without ST segment elevation (NSTEMI) are not accompanied by the appearance of a pathological Q wave and are characterized by a general complex pathogenesis associated with progressive atherosclerosis, a non-occlusive thrombus in the area of erosion or rupture of an atherosclerotic plaque, vasospasm, coronary microcirculatory dysfunction or other causes of imbalance between oxygen intake and oxygen consumption resulting in myocardial ischemia, and are distinguished by increased levels of myocardial necrosis in the blood in case of NSTEMI. It is difficult to differentiate UA and NSTEMI in the first hours of the development of the process when a decision is made on reperfusion technologies and drug therapy without laboratory, and in some cases, additional examination with visualization of the probable new loss of viable myocardium, therefore, the diagnosis and management of these two clinical conditions are usually considered in the same clinical recommendations. A fairly common point of view that the risk of death in UA is significantly lower and the patient is less in need of an intensive strategy than with verified NSTEMI, is controversial given the likely cases of sudden cardiac death of ischemic genesis at the prehospital stage and the difficulties of differential diagnosis of these clinical states. The factors contributing to diagnostic errors include severity of the patient's condition, a variety of clinical atypical manifestations and pathophysiological mechanisms of myocardial ischemia, the presence of comorbid pathology. The article discusses various mechanisms of the development of myocardial ischemia, diagnostic and therapeutic invasive and non-invasive technologies that improve the prognosis of patients with UA. The optimal management tactics of NSTEACS includes early diagnosis and risk stratification, emergency hospitalization, monitoring, the use of non-invasive and invasive strategies, including coronary angiography and revascularization, as well as emergency and long-term treatment aimed at preventing acute cardiovascular events taking into account the age, gender differences and comorbid pathology. A differentiated approach to the administration of emergency therapy is the key to improving the prognosis of this high-risk category of patients. Due to the lack of the possibility of using revascularizing technologies in patients with obstructive coronary disease, non-pharmacological technologies that positively affect microcirculation processes are likely to be used: exposure of the patient’s blood to an alternating magnetic field (extracorporeal autohemomagnetotherapy) or to ultraviolet optical radiation (ultraviolet blood modification). In view of the difficulty in identifying the mechanism of myocardial ischemia in each individual patient with UA and a high likelihood of combination of various pathophysiological factors, myocardium rescue should be in the focus of therapeutic intervention, which dictates the validity and utility of all the recommended and available methods of pharmacological and non-pharmacological therapy and revascularization to reduce the effects of myocardial ischemia.

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Impact of fractional flow reserve on decision-making in daily clinical practice: A single center experience in Egypt

Cited by 3 publications

References 23 publications

Evaluating the Impact of Fractional Flow Reserve (FFR) on Decision-Making for Treatment of Borderline Coronary Artery Lesions:

Evaluating the Impact of Fractional Flow Reserve (FFR) on Decision-Making for Treatment of Borderline Coronary Artery Lesions:

Management of Culprit and Non-Culprit Lesions in Acute Coronary Syndrome

Unstable Angina Pectoris or Unstable Coronary Syndromes?

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