Global FFR as Prognosis in CAD Patients without Ischemia

Global fractional flow reserve (FFR) results from adding up FFR values of the three major coronary arteries. This figure represents the physiological atherosclerosis burden and can predict events at long term in patients without stenosis leading to ischemia.

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This recent study published in JAHA looked at major cardiovascular events (death, infarction and revascularization) at 5 years in 1122 patients with no significant stenosis (lesions with FFR > 0.8 n=275) or presenting at least one significant lesion successfully treated (post PCI FFR > 0.8 n=847).

FFR was measured in the three main coronary arteries and these values were added to stratify patients into global FFR tertiles (low ≤ 2.80, intermediate between 2.80 and 2.88, and high ≥ 2.88).

Patients in the lowest tertile presented more events at 5 years compared against the intermediate and high tertiles (27.5% vs 22.0% and 20.9%, respectively; p=0.040).

The highest events rate in the group with low global FFR was driven mainly by more revascularization (16.4% vs 11.3% and 11.8%, respectively; p=0.038).


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For each additional 0.1 FFR there was a significant reduction in total events (HR 0.988; CI 95%, 0.977 to 0.998; p=0.023), infarctions (HR 0.982; CI 95%, 0.966 to 0.998; p=0.032) and revascularization (HR 0.985; CI 95%, 0.972 to 0.999; p=0.040).

This is one of the studies that most clearly shows the concept of FFR as a continuous variable with a large spectrum of greys, as opposed to a binary variable below or over 0.8. 

Conclusion

Global FFR (the added FFR values of the three main cardiac arteries) is capable of predicting events at 5 years even in patients without ischemia driven by stenosis. Global FFR can be interpreted as the burden of physiological atherosclerosis.

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Original Title: Global Fractional Flow Reserve Value Predicts 5-Year Outcomes in Patients With Coronary Atherosclerosis But Without Ischemia.

Reference: Stephane Fournier et al. J Am Heart Assoc. 2020;9:e017729.  DOI: 10.1161/JAHA.120.017729.


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