In patients with coronary disease, the prognosis depends on the extent and reversibility of myocardial ischemia. Whether the outcome also depends on the severity of stenosis as determined by fractional flow reserve (FFR) has not been studied yet.

This study investigates the relationship between fractional flow reserve values and vessel-related events. Major adverse cardiovascular events (MACE) at 2 years were prospectively studied in 607 patients in whom all stenoses were assessed by FFR and who received medical therapy only.

Moreover, logistic regression models were used to calculate the decrease in the risk per 0.05 increase in FFR values.

Events were present for 272 (26.5%) of 1029 lesions. Lesions with stenosis diameter ≥70% were more often present in the group experiencing events (p <0.01).

The mean fractional flow reserve value was significantly lower in the group experiencing events than in the group with no events (0.68 vs. 0.80; p <0.01).

The cumulative incidence of MACE significantly increases with increasing FFR quartiles.

The average decrease in MACE per 0.05 increase in FFR was statistically significant, even after adjustment for all clinical and angiographic variables. The strongest increase in adverse events occurred for FFR values between 0.80 and 0.60. In a multivariate analysis, FFR was significantly associated with events at 2 years

Conclusion

In patients with stable coronary disease, functional severity of a lesion as assessed by fractional flow reserve is independently associated with major cardiovascular events.

Original title: A Prospective Natural History Study of Coronary Atherosclerosis Using Fractional Flow Reserve.

Reference: Emanuele Barbato et al. J Am Coll Cardiol. 2016;68(21):2247-2255.

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