Author + information
- Ki Hong Choi1,
- Joo Myung Lee2,
- Bon-Kwon Koo3,
- Eun-Seok Shin4,
- Chang-Wook Nam5,
- Joon-Hyung Doh6,
- Doyeon Hwang3,
- Jonghanne Park7,
- Hong-Seok Lim8,
- Myeong-Ho Yoon9 and
- Seung-Jea Tahk8
- 1Samsung Medical Center, Seoul, Korea, Republic of
- 2Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of
- 3Seoul National University Hospital, Seoul, Korea, Republic of
- 4Ulsan University Hospital, Ulsan, Korea, Republic of
- 5Keimyung University Dongsan Medical Center, Daegu, Korea, Republic of
- 6Inje University Ilsan Paik Hospital, Seoul, Korea, Republic of
- 7Ministry of Health and Welfare, Seoul, Korea, Republic of
- 8Ajou University Medical Center, Suwon, Korea, Republic of
- 9Department of Cardiology, Ajou University School of Medicine, Suwon, Korea, Republic of
There are limited data on the prognosis of deferred non-culprit lesion in patients with acute coronary syndrome (ACS) based on fractional flow reserve (FFR). We investigated the prognosis of deferred non-culprit lesion in ACS patients, compared with deferred lesions in patients with stable coronary artery disease (SCAD) on the basis of FFR.
The clinical outcomes of 449 non-culprit lesions (301 ACS patients) were compared with 2,484 lesions (1,295 SCAD patients) in which revascularization was deferred on the basis of a high FFR (>0.80). The primary outcome was major adverse cardiac events (MACE), a composite of cardiac death, target vessel-related myocardial infarction (MI) and ischemia-driven revascularization.
Among the ACS population, 65.8% presented with unstable angina and 34.2% were with non-ST segment elevation MI. Mean angiographic % diameter stenosis and FFR of the deferred lesions were 39.3±15.0% and 0.92±0.06, respectively. During the median follow-up duration of 722.0 days, the deferred non-culprit lesions of ACS patient showed significantly higher rate of MACE (3.8% vs. 1.6%, HR 2.97, 95% CI 1.23-7.17, p=0.016). Regardless of the range of FFR in the deferred lesions (0.81-0.85, 0.86-0.90, 0.91-0.95, and 0.95-1.00), non-culprit lesion of ACS showed more than 2-folds higher rates of MACE than that of SCAD. ACS was the most powerful independent predictor of MACE (HR 2.74, 95% CI 1.13-6.64, p=0.026).
Compared to the deferred lesions of SCAD patients, deferred non-culprit lesion of ACS on the basis of FFR showed a higher rate of clinical events regardless of FFR range.
IMAGING: FFR and Physiologic Lesion Assessment