Fractional flow reserve (FFR) has proven to be superior to angiography as a guide to revascularization due to a significant reduction in the number of both long-term and short-term events. Furthermore, deferring treatment of lesions without evidence of ischemia offers an excellent prognosis. Many studies including mostly stable patients showed a significant degree (as high...
Collateral circulation develops during the gradual progression of coronary occlusions in order to replace the original artery and supply blood to areas jeopardized by ischemia. However, the relevance of collaterals has remained controversial for many years. Several works have suggested a rapid regression of collaterals after rechanneling of chronic total coronary occlusions, which could render...
Courtesy of the SBHCI. About 50% of patients admitted with acute ST-segment elevation myocardial infarction also present lesions in another vessel. Whether to treat these or not, and the optimal moment to treat non-culprit infarction-related vessels are still controversial issues. The COMPARE-ACUTE study was recently published and showed that fractional flow reserve (FFR)-guided complete...
The safety of physiology-based coronary revascularisation has been supported by evidence for years now. DEFER (1998-2001) was one of the first related studies. However, major changes in device and medical treatment safety and efficacy have taken place since then. This could affect clinical results, particularly as regards acute coronary syndromes (ACS). Several studies have cast...
Courtesy of Dr Carlos Fava. The association of primary angioplasty with multivessel lesions is not infrequent and has been analyzed in various studies and meta-analyses. However, the proper course of action remains unclear. According to this study, fractional flow reserve (FFR) could better define the ischemic impact of lesions and help with the identification of...
In the initial management of patients with stable chronic angina, a non-invasive strategy with cardiovascular MR perfusion imaging seems to provide similar results to invasive strategies. At one year, MACE rate (combination of all cause death, non-fatal infarction and target vessel revascularization) resulted 3.3% for MRI vs. 3.9% for fractional flow reserve (FFR) informed...
Using fractional flow reserve (FFR) to guide revascularization of all functionally significant lesions in the setting of acute coronary syndrome appears to improve outcomes over treating only the culprit artery, according to the Compare-Acute trial. This study, conducted at 24 centers in Europe and Asia, enrolled 885 patients who were stable following successful primary angioplasty and...
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...
Courtesy of Dr. Carlos Fava. Between 40% and 70% of patients undergoing transcatheter aortic valve replacement (TAVR) present coronary lesions. The fact that aortic stenosis affects how blockages act, and that, after stenosis correction, hemodynamic compromise for those same lesions may vary, has been consistently proven. Its management has not been determined yet. The study...
The FUTURE study, testing the utility of functional revascularization by measuring the fractional flow reserve (FFR), was halted early by its safety committee due to an increased mortality rate at 1 year among patients guided by FFR. In this unexpected unprecedented outcome, 17 patients in the FFR-guided group died at a year of follow-up, compared with 7 patients...