Coronary Flow Reserve in Patients with Intermediate FFR: Should We Use This Tool to Define When to Perform Coronary Angioplasty?

Current guidelines recommend using fractional flow reserve (FFR) to guide coronary angioplasty. However, intermediate FFR values (0.75-0.80) generate uncertainty about the prognostic value of performing coronary angioplasty over optimal medical treatment.

reserva fraccional de flujo sindrome coronario agudo

The use of coronary flow reserve (CFR) together with FFR provides further insight into coronary circulation because CFR is an index that also includes microcirculation assessment.

The aim of this retrospective study was to evaluate the prognosis between deferring vs. performing coronary angioplasty according to CFR score in patients with intermediate FFR.

The endpoint was treated vessel failure (TVF), defined as a composite of cardiovascular death, treated-vessel-related infarction, and clinically driven repeat vascularization of the treated vessel.

Out of the 2322 patients in the ILIAS Registry (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry), 400 had intermediate FFR stenosis and were included in this study. Coronary angioplasty was differed in 210 patients (deferred group) and it was performed in 190 patients (performed group). They were further stratified according to CFR value into preserved CFR (>2) and decreased CFR (≤2).

Mean patient age was 60 years old. The most frequent clinical presentation was unstable angina. The most frequently treated artery was the anterior descending artery. According to CRF, angioplasty was performed in 38% of the preserved CFR cohort, and in 61% of the decreased CRF cohort.

Read also: Prophylactic Rivaroxaban Therapy for Left Ventricular Thrombus after ST-Segment Elevation Acute Coronary Syndrome.

There were no significant differences in TVF between groups at 5 years of follow-up. However, when performed in decreased CRF patients, the risk of TVF was higher for the deferred group when compared with the performed group (17.2% vs. 14.2%, hazard ratio: 4.932; 95% confidence interval: 1.312 to 18.53; p = 0.018). This difference was at the expense of a higher rate of revascularization of the treated vessel (12.1% vs. 8.3%; p = 0.025).

Conclusion

In patients with an intermediate FFR of 0.75-0.80, the prognostic value of the therapeutic strategy differed according to CFR value. Coronary angioplasty was associated with a lower rate of TVF when the CFR was decreased. However, there were no differences in TVF in patients with preserved CFR.

CFR can be used to stratify risk in patients with intermediate FFR to determine therapeutic strategy.

Dr. Andrés Rodríguez
Member of the Editorial Board of SOLACI.org .

Original Title: Differential Prognostic Value of Revascularization for Coronary Stenosis With Intermediate FFR by Coronary Flow Reserve.

Reference: Juwon Kim, MD et al J Am Coll Cardiol Intv 2022.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

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...