Author + information
- Ahmed A. Almomania,b,
- Naga Venkata Pothinenia,b,
- Mohan Mallik Edupugantia,b,
- Jason Paynea,b,
- Shiv Kumar Agarwala,b,
- Barry Uretskya,b and
- Abdul Hakeema,b
Background: Fractional flow reserve (FFR) has been shown to improve clinical decision-making for revascularization in intermediate coronary stenosis in native coronary arteries. Howerver, its use for saphenous vein graft (SVG) lesions has not been well validated. We sought to determine the prognostic value of deferring intervention on lesions with FFR>0.8 in SVG lesions.
Methods: Clinical, angiographic, hemodynamic data and long-term outcomes were recorded in consecutive patients in whom angioplasty was deferred based on an FFR >0.8 for intermediate native coronary artery or SVG stenosis.
Results: 532 patients underwent native vessel FFR and 32 patients underwent FFR of SVG lesions. There was no difference between the groups (SVG/non SVG) in age [66.6 (IQR 63–76) vs. 65 (IQR 61–70); p=0.12]; diabetes (41% vs. 50%; p=0.35); hypertension (94% vs. 97%; p=0.71). Patients in the SVG group had higher prevalence of CKD (44% vs. 23%; p<0.0001). During a median follow up of 3.2 years (IQR 1.7–4.6 years) MACE was significantly higher in SVG group (35% vs. 22%; log rank p=0.01). Similarly the rates of myocardial infarction and target vessel failure were significantly higher in the SVG group (26% vs. 15%; p=0.02). SVG lesions were independent predictors of MACE on Cox proportional hazards analysis (HR 2.5; 95% CI 1.2–5.3; p=0.007).
Conclusions: Non-ischemic FFR carries a significantly worse prognosis in SVG compared to non-SVG lesions. Caution is warranted in utilizing FFR for clinical decision-making in SVG lesions.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Interventional Cardiology: Intravascular Physiology and Endothelial Function
Abstract Category: 23. Interventional Cardiology: IVUS and Intravascular Physiology
Presentation Number: 1115-172
- 2017 American College of Cardiology Foundation