5-year TVF and MACCE in patients with deferred of revascularization after FFR: Is FFR enough?

Fractional flow reserve (FFR) has been shown effective and safe by different studies, yet not at 5 years.

Eventos cardiovasculares a 5 años luego de postergar la revascularización guiada por FFR, ¿Debemos guiarnos sólo por el valor obtenido con esta técnica?

The aim of this multicenter registry was to assess the impact of thrombotic risk (as per CREDO-Kyoto score) as a predictor of cardiovascular events at 5 years in patients with deferred revascularization after FFR measurement.

The score used in this study was only validated for the Japanese population; it includes variables such as chronic kidney failure, atrial fibrillation, peripheral vascular disease, anemia, age >75, cardiac failure and diabetes.

Cardiovascular events related to the treated vessel were considered target vessel failure (TVF), and defined as a composite of cardiovascular death, target vessel MI, and clinically driven TVF, while patient related events were considered MACCE (including total death, cerebrovascular events, AMI and revascularization).

They looked at 1263 patients, mean age 70, mostly hypertensive and dyslipidemic. The most frequent clinical presentation was stable angina, and the anterior descending was the most treated vessel.

At 5 years, patients at high risk, according to this score, showed greater MACE rate, at the expense of all cause death. In addition, this group of patients presented a higher rate of TVF. Patients with positive FFR had a higher incidence of TVF at the expense of clinical guided revascularization at 5 years.

There were no differences in MACCE between FFR positive and negative patients at 5 years.

Patients at high risk of thrombosis and negative FFR presented the highest rate of TVF and MACCE.

Conclusion

Among CAD patients with deferred revascularization after FFR, thrombotic risk and FFR value were associated to MACCE and TVF at 5 years. Patients with high thrombosis risk presented the highest risk, even with negative FFR.