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Fractional flow reserve-guided angioplasty predicts acute coronary syndromes in previously non-stented vessels
Session:
Painel 8 - Doença Coronária 3
Speaker:
José Lopes De Almeida
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Posters
FP Number:
---
Authors:
José Lopes De Almeida; Patrícia M. Alves; Célia Domingues; Ana Vera Marinho; Ana Maria Lé; Luís Candal Leite; Elisabete Jorge; Sofia S. Martinho; Maria João Ferreira; Lino Gonçalves
Abstract
<p><strong>BACKGROUND</strong>: Physiology guided revascularization (either by fractional flow reserve – FFR or instantaneous wave-free ratio – iwFR) is essential in the management of coronary artery disease. There are no specific orientations regarding its use after percutaneous coronary intervention (PCI). We aimed to assess the prognostic value of FFR/iwFR in previous PCI vessels <em>versus</em> non-stented vessels.</p> <p><strong>METHODS:</strong> We conducted a retrospective study including all 196 patients that underwent coronary physiology assessment previous to angioplasty in our interventional cardiology unit from April 2015 to October 2017. A cutoff value of FFR ≤ 0.80 and/or iwFR ≤0.89 guided the decision of revascularization. Patients were followed-up for a median 18 (IQR 13-26) months. Outcomes regarding all cause death and ACS were collected.</p> <p><strong>RESULTS: </strong>The mean age was 65.0±10.9 years and 78.6% were male. About 27% had previous PCI. Left anterior descending coronary artery (LAD) was the most frequent diseased vessel (74.5% cases). PCI was performed in 38.3% cases, the majority in LAD lesions (27.6%). ACS at follow-up was predicted by LAD FFR and previous LAD PCI (p <0.05), but not by ACS at presentation. LAD FFR was only associated with ACS at follow-up in patients with no previous LAD PCI (p=0.038).</p> <p><strong>CONCLUSIONS: </strong>In this FFR-guided PCI study population, ACS at follow-up was predicted by LAD FFR and previous LAD PCI. Importantly, LAD FFR predicted ACS at follow-up in patients with no previous LAD PCI. These results might suggest the use of immediate post-PCI FFR evaluation, to exclude the presence of residual ischemia and improve outcomes.</p>
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