Reliability of FFR in Patients with Diabetes: Are Other Parameters Necessary?

Diabetes does not seem to alter the results of a fractional flow reserve (FFR) measurement in a given lesion. Recently, expert opinions and small studies had questioned the reliability of FFR in this specific patient subgroup. This new observational study soon to be published in JAMA vanquishes all doubts and confirms the efficacy of this method in patients with diabetes.

FFR en diabéticos

According to this new observational analysis from the PRIME-FFR study, FFR can safely guide the decision-making process in patients both with and without diabetes.

There were some concerns about microcirculatory responsiveness to adenosine and the potential for accelerated atherosclerosis in deferred lesions in diabetic patients, but these uncertainties seem less warranted after reading the analysis.

For this analysis, investigators used data from the PRIME-FFR study, which in turn combines data from two prospective multicenter registries: POST-IT and R3F. In total, there were 1983 patients; one third of them had a history of diabetes.


Read also: Coronary Disease in Diabetes: Diabetic Patients Have Much Greater Plaque Progression.


FFR was measured on average for 1.4 lesions per patient and, in patients with and without diabetes, there were the same independent risk factors for lower FFR values (age, anterior descending artery disease, stenosis percentage, lesion length, and number of diseased vessels).

Similar proportions of patients with and without diabetes were reclassified by FFR results from one revascularization strategy to another (41.2% and 37.5%, respectively; p = 0.13).

Patients with diabetes were actually more likely to shift from initial medical therapy to revascularization compared with patients without diabetes (41.5% vs. 31.5%; p = 0.001).


Read also: Silent Diabetes Is the New Stealthy Enemy.


Combined events (all-cause death, infarction, or unplanned revascularization) at one year were more frequent in diabetic patients (11.3% vs. 9%). Such rate did not differ between patients who were and were not reclassified by FFR.

Patients with deferred revascularization based on FFR >0.8 had similar event rates regardless of their diabetes status (8.4% vs. 7.9%; p = 0.87).

Patients for whom FFR results were disregarded while deciding the revascularization strategy experienced almost twice as many events as other patients (17.5% vs. 9.2%; p = 0.002).


Read also: Does a Combination of Diabetes and Acute Coronary Syndrome Change the Revascularization Strategy?


Given the scarce evidence we have, this work seems the best alternative to bring peace of mind and confirm that we should make our decisions based on FFR results, regardless of patient glycemic levels.

Original Title: Usefulness of routine fractional flow reserve for clinical management of coronary artery disease in patients with diabetes.

Reference: Van Belle E et al. JAMA Cardiol. 2020; Epub ahead of print.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

CRABBIS Trial: Comparison of Different Provisional Stenting Sequences

Provisional stenting (PS) is the gold standard for percutaneous coronary intervention (PCI) in most patients with coronary bifurcation lesions (CBL). Moreover, recent studies such...

Andromeda Trial: Meta-Analysis of Drug Coated Balloon vs. DES in Small Vessel DeNovo Lesions

The use of coronary stents vs plain old balloon angioplasty (POBA), has allowed to reduce recoil and limiting flow dissection which were major limitation...

QFR vs. FFR: Is Coronary Revascularization Deferral Safe? Results from a FAVOR III Sub-Analysis

In cases of intermediate coronary lesions, functional assessment is recommended to aid the decision-making process regarding revascularization. There are several tools currently used to...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...