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Outcomes after flow reserve assessment in lesions submitted to prior stenting: as safe as it can be?
Session:
Posters 3 - Écran 03 - Isquemia/SCA
Speaker:
CELIA DOMINGUES
Congress:
CPC 2018
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Posters
FP Number:
---
Authors:
Célia Domingues; Elisabete Jorge; Patrícia M. Alves; Ana Vera Marinho; Manuel Oliveira Santos; Luís Candal Leite; James Milner; Cátia Santos Ferreira; João Marques; João Calisto; Vitor Azevedo Matos; Mariano Pêgo; Maria João Vidigal Ferreira
Abstract
<p><strong>Introduction:</strong> Effective selection of coronary lesions?for revascularization is pivotal in the management of symptoms and adverse outcomes in patients with coronary artery disease (CAD). Revascularization guided by fractional flow reserve (FFR) is associated with better outcomes than angiography-only guided revascularization. Recently, instantaneous ‘wave-free’ ratio (iFR) has been proposed as a new diagnostic index for assessing the severity of coronary lesions without the need for pharmacological vasodilation. Evidence of the effectiveness of iFR-guided revascularization is emerging, as it could replace FFR as the standard functional assessment test. We aimed to compare our initial experience with iFR with the more validated FFR, regarding 1-year safety outcomes.</p> <p><strong>Methods: </strong>We conducted a retrospective analysis of all patients with CAD who underwent either iFR- or FFR-guided revascularization between 1<sup>st</sup> August of 2014 and 31th November of 2016 . The primary safety endpoint was the 1-year risk of major adverse cardiac events (death from any cause, nonfatal myocardial infarction (MI), or unplanned revascularization). All lesions considered functionally significant were treated, whether by angioplasty (57) or surgery (3).</p> <p><strong>Results:</strong> A total of 174 vessels were evaluated by FFR, whereas 52 were assessed by iFR. The number of vessels evaluated per patient (2 vessels per patient in 26.4 vs. 27.7%, p= 0.40) and the number of functionally significant stenosis did not differ among groups (31.6 vs 26.0%, P=0.39, in the FFR group and the iFR group, respectively. At 1 year follow-up, the primary outcome had occurred in 11 of 145 patients (7.6%) in the FFR group and in 3 of 36 patients of the iFR group (8.3%) (HR 0.82, <em>P</em>=0.79).</p> <p>In FFR group occurred 8 dead, 5 of them cardiac dead (4 MI), 3 nonfatal MI and not occurred any unplanned revascularization. All (fatal and nonfatal MI) occurred in vessels with previous PCI, 4 of them is previous evaluated has non functionally significant stenosis.</p> <p>In iFR group occurred 2 cardiac dead and 1 nonfatal MI, and MI occurred too in vessel with previous PCI and previous non functionally significant stenosis.</p> <pre> <strong>Conclusions</strong>: We found similar 1-year safety outcomes in this real-world cohort of CAD patients that underwent functional assessment of coronary lesions guided either by iFR or FFR. </pre> <pre> Importantly, the events that occurred at the site of previous stent implantations, suggesting that both FFR and iFR may have limitations assessing previously stented lesions.</pre> <p> </p>
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