clinical outcomes following treatment of bordeline coronary stenosis based on FFR decision making strategy

Background

Functional Flow Reserve (FFR) test is used to evaluate hemodynamic significance of borderline coronary artery stenosis, and the need for PCI.

The primary purpose of this study was to evaluate Major Adverse Cardiovascular Events (MACE) incidence by the end of 5-years follow-up following treatment of moderate severity coronary stenosis based on FFR decision making strategy (by PCI + OMT or OMT by itself)

Methods

The study retrospectively included 360 patients admitted at the interventional cardiology unit in Bnai Zion medical center during 2011-2015 who went FFR study .we include 180 patients with FFR> 0.8 treated by OMT without invasive intervention (High FFR group) and 180 patients who were treated by PCI and OMT according to FFR threshold below 0.8 (Low FFR group). An electronical clinical follow-up of 5 year was conducted for each population group.

Results

The majority of clinical characteristics were similar in both groups. male gender, obesity and history of IHD were more common in the the low FFR group.

The clinical presentation of the two groups was similar (74-77% stable angina pectoris, 12-13% UAP, 9-11% NSTEMI).

MACE (composite of CV death , MI, Stroke and need for Revascularization) occurred at 19 pts (10.5%) and 52 pts (28.9%) in the high and the low FFR groups respectively (P<0.01), mainly due to higher prevalence of revascularization procedures at the low FFR group, 33 procedures (9.2%) in comparison to 7 procedures (3.9%) at the high FFR group. A higher incidence of MI was also recorded at the low FFR group. The incidence of CV death was similar in both groups.

Conclusions

despite PCI in addition to OMT in the low FFR group 5 year clinical outcomes still being significantly worse compared to high FFR group, mainly due to the need of more revascularization procedures and the incidence of MI.