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Functional assessment-guided coronary revascularization in acute coronary syndromes: it keeps functioning!
Session:
CO 02 - Isquemia/SCA
Speaker:
CELIA DOMINGUES
Congress:
CPC 2018
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.1 Invasive Imaging and Functional Assessment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Célia Domingues; Elisabete Jorge; Rui Baptista; Ana Vera Marinho; James Milner; Patrícia M. Alves; Manuel Oliveira Santos; Luís Candal Leite; João Marques; João Calisto; Vitor Azevedo Matos; Mariano Pêgo; Maria João Vidigal Ferreira
Abstract
<p><strong>Background:</strong> In acute coronary syndromes without ST elevation (NSTEACS), the identification of the culprit, unstable plaque is sometimes difficult to identify by quantitative angiography. Conversely, in stable coronary artery disease (SCAD), usually the challenge is to correctly quantify the severity of the lesion. In both scenarios, acute functional assessment of non-culprit stenosis may be considered. We aimed to characterize patients with NSTEACS submitted to coronary revascularization guided by fractional flow reserve (FFR) or instantaneous ‘wave-free’ ratio (iFR) and to compare their outcomes with patients with SCAD.</p> <p><strong>Methods:</strong> We included all patients submitted to functional assessment-guided coronary revascularization from 1<sup>st</sup> August of 2014 to 31th November of 2016 in our laboratory. Mean follow up was 350 ± 58 days. </p> <p>The patients were divided in two groups: group 1, NSTEACS patients and group 2, SCAD patients. The primary outcome was a composite of all-cause mortality, nonfatal myocardial infarction or unplanned revascularization.</p> <p><strong>Results:</strong> We enrolled a total of 172 (60 NSTEACS and 112 SCAD) patients. Mean age was 62±12 years vs 67±10 y (p=0.13) and 47 (78,3%) vs 90(80,4%) of patients were male, p=0,75. Regarding cardiovascular risk factors, 43 (74,1%) vs 95 (88%) of patients had hypertension, p=0,023; 12 (20,3%) vs 41 (38%) had diabetes mellitus, p= 0,019; 55 (91,7%) vs 98 (87,5%) had dyslipidemia, p=0,66, and 24 (40,7%) vs 34 (31,5%) were present or past smokers, p=0,23. Mean LVEF in group 1 and 2 was 51 ± 11% vs 52 ± 11%, respectively (p=0.67). As expected, FFR was used more commonly in both groups (75 vs 82%) than iFR (25 vs 18%). The number of vessels evaluated were 74 vs 131, with a mean of 1.3±0.5 vs 1.3 ±0.5 vessels evaluated per patient. The number of functionally significant stenosis was also similar among groups (28 vs 31%, p=0.73). Regarding the primary composite outcome, no differences were found between the two groups: 9 patients in the NSTEACS group (7%) and 4 patients (9%) in th SCAD group, p=0.700, Table 1.</p> <p><strong>Conclusions:</strong> Both in NSTEACS and SCAD, functional assessment-guided coronary revascularization is a safe and effective strategy. The hypothesis that non-flow limiting vulnerable unstable plaques in NSTEACS patients could increase the incidence of outcomes in patients with negative functional assessments by FFR and iFR is not demonstrated in our series. In fact, NSTEACS patients had a lower incidence of the primary outcome than SCAD patients. FFR and iFR proved be equally useful in patients with NSTEACS and with SCAD.</p>
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