Optimal Treatment Strategy for Coronary Artery Stenoses with Grey Zone Fractional Flow Reserve Values. A Systematic Review and Meta-Analysis

Andreou, Constantinos; Zimmermann, Frederik M.; Tonino, Pim A.L.; Maniotis, Christos; Koutouzis, Michalis; Poulimenos, Leonidas; Triantafyllis, Andreas S.

doi:10.1016/j.carrev.2019.05.018

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…Nevertheless, this difference was not statistically significant (P value = 0.099). This too was similar to what Andreou, et al [31] and Hennigan, et al [27] reported in their studies, where Andreou, et al reported that after a 2.4 years followup period, the relative risk for MACE was 1.33 but no statistical significance was found (p value = 0.35). Likewise, Hennigan, et al found that equal number of patients in each of the performed and the deferred groups had cerebrovascular diseases and accordingly no statistical difference was detected.…”

Section: Discussionsupporting

confidence: 88%

“…However, several studies have reported that a small group of patients with FFR between 0.75 and 0.80, the so-called grey zone FFR, were associated with reversible myocardial ischemia [24,25]. This also agrees with what both Andreou, et al [31] and Shin, et al [32] reported. This finding is reasonable since the recruited patients were similar in their clinical data upon which they were chosen and with similar FFR ratios and so it is expected that they would possess similar cardiac risk factors with no significant difference.…”

Section: Discussionsupporting

confidence: 77%

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Deferred vs. Performed Percutaneous Coronary Intervention for Coronary Stenosis with Grey-Zone Fractional Flow Reserve Values

Mohamed Abdelsalam Ali,

Hesham Hegazy,

Mohamed Ahmed

et al. 2023

Int J Clin Cardiol

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Background: Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) has shown better clinical outcomes than conventional angiography-guided PCI. The optimal FFR cut-off value for revascularization is debated. With FFR ≤ 0.75, revascularization for coronary artery disease (CAD) stenosis is associated with improved clinical outcomes, whereas with FFR ≥ 0.8, medical treatment has been shown to result in favorable long-term outcomes. However, there has been controversy over revascularization decision-making for coronary stenosis with FFR between 0.75 and 0.80, the so-called grey zone.Objectives: The present study aims to compare intermediate-term outcomes of performed versus deferred Percutaneous Coronary Intervention in moderate coronary stenosis with FFR values in the grey zone (0.75-0.80) and the primary outcome will be six months major adverse cardiac event (MACE).Methods: A non-randomized prospective clinical study was conducted over 3 years period between January 2019 and January 2022. The study included stable CAD patients with coronary lesions between 40-70% diameter stenosis who underwent FFR study using intracoronary (IC) adenosine and had FFR values between 0.75-0.80 and were divided into two groups: group 1 who have undergone revascularization and group 2 who have undergone deferred revascularization.Results: This study was conducted on 50 patients with moderate coronary artery stenosis with an FFR value in the grey zone undergoing performed or deferred revascularization. The age of the studied group ranged from 38-67 (mean 53.16 ± 7.83) years. The studied group included 12 females (24%) and 38 males (76%). 72% of the patients have diabetes, 70% hypertension, 94% dyslipidaemia and 52% were smokers. There was no significant difference between patients undergoing performed or deferred PCI as regard the risk factors (p-value 0.697).The most common culprit vessel is the left anterior descending (LAD) (64%) followed by right coronary artery (RCA) (20%) then left circumflex (LCX) (16%). 54% of the patients have undergone performed PCI while 46% have undergone deferred PCI with LAD (33.3% and 26.0%) followed by RCA (8.6% and 11.4%) then LCX (7.4% and 8.6%) respectively. There was no significant difference between patients undergoing performed or deferred PCI in regard to either the value of FFR or Culprit vessel (p-value 0.157, 0.232). 87.7% of the patients were asymptomatic after six months, stable and had no MACE. Six patients were symptomatic with MACE 6 patients had target vessel revascularization (TVR) (2 in group 1 and 4 in group 2) with 3 myocardial infarction (MI) (1 post-procedure in group 1 and 2 spontaneous in group 2) and one patient died after 3 months (group 1).

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 77%

Deferred vs. Performed Percutaneous Coronary Intervention for Coronary Stenosis with Grey-Zone Fractional Flow Reserve Values

Mohamed Abdelsalam Ali,

Hesham Hegazy,

Mohamed Ahmed

et al. 2023

Int J Clin Cardiol

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show abstract

“…A meta-analysis by Andreou et al pooled the results of 6 non-randomised studies including more than 2300 patients, showing no differences between PCI and OMT in stenosis within the FFR grey zone. 44 Thereafter, a small randomised trial has confirmed these results, although in a cohort of only 104 patients. 45 Importantly, a subanalysis from the DEFER trial showed that FFR measurement significantly loses accuracy within the grey zone (particularly when approximating 0.80) with concrete possibilities that FFR-based recommendation would change across repeat measurements obtained a few minutes apart.…”

Section: Introductionmentioning

confidence: 94%

Why percutaneous revascularisation might not reduce the risk of myocardial infarction and mortality in patients with stable CAD?

Benenati,

De Maria,

Kotronias

et al. 2023

Open Heart

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Percutaneous coronary intervention (PCI) is widely adopted to treat chronic coronary artery disease. Numerous randomised trials have been conducted to test whether PCI may provide any prognostic advantage over oral medical therapy (OMT) alone, without definitive results. This has maintained the paradigm of OMT as the first-line standard of care for patients, reserving PCI for symptom control. In this review, we discuss the current evidence in favour and against PCI in stable coronary syndromes and highlight the pitfalls of the available studies. We offer a critical appraisal of the possible reasons why the existing data does not provide evidence supporting the role of PCI in improving clinical outcomes in patients with stable coronary syndromes.

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“… 3 Thus, FFR of the coronary stenosis after TAVI might be lower than before TAVI 2 . In addition, researchers have proposed the use of the ‘grey zone’ FFR concept 4 in patients with concomitant severe AS and CAD. 2 In this population, FFR values pre-TAVI between 0.80 and 0.85 demarcate the ‘grey zone’, that might drop to <0.75 post-TAVI.…”

mentioning

confidence: 99%

Optimal Treatment Strategy for Coronary Artery Stenoses with Grey Zone Fractional Flow Reserve Values. A Systematic Review and Meta-Analysis

Cited by 6 publications

References 24 publications

Deferred vs. Performed Percutaneous Coronary Intervention for Coronary Stenosis with Grey-Zone Fractional Flow Reserve Values

Deferred vs. Performed Percutaneous Coronary Intervention for Coronary Stenosis with Grey-Zone Fractional Flow Reserve Values

Why percutaneous revascularisation might not reduce the risk of myocardial infarction and mortality in patients with stable CAD?

Hyperaemic and non-hyperaemic indices for functional assessment of coronary lesions in patients with severe aortic valve stenosis

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