Author + information
- Luis Raposo1,
- Sergio Baptista2,
- Ruben Ramos3,
- Lino Santos4,
- Elisabete Jorge5,
- Carina Machado6,
- Joao Costa7,
- Luis Nunes8,
- Maria João Sousa9,
- Alberto Rodrigues10,
- Luis Seca11 and
- Renato Fernandes12
- 1Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
- 2Hospital Fernando Fonseca, Amadora, Portugal
- 3Hospital de Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
- 4Centro Hospitalar Gaia/Espinho, Porto, Portugal
- 5Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- 6Hospital do Divino Espírito Santo, Ponta Delgada - Açores, Portugal
- 7Hospital Braga, Braga, Portugal
- 8Hospital de São Teotónio, Viseu, Portugal
- 9Hospital de S. António, Porto, Portugal
- 10Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
- 11Centro Hospitalar de Trás-os-Montes e Alto Douro - Vila Real, Porto, Portugal
- 12Hospital do Espírito Santo, Evora, Portugal
Lesion-specific outcomes, especially safety of FFR-based deferral, are understudied in the setting of ACS. We assessed the clinical outcome of ACS lesions as a function of FFR-based treatment, as compared to non-ACS.
In a prospective study (N=918 patients; 19 hospitals), FFR was successfully measured in 453 lesions/325 pts in the setting of an ACS (except acute STEMI) and in 787 lesions/556 stable CAD pts. Management was according to FFR in 94% of cases, using the 0.80 cut-off. Lesions were grouped according to management strategy: Group 1 (deferred with FFR>0.80; ACS=267 vs. non-ACS=432); Group 2 (revascularized; 171 vs. 301); Group 3 (deferred with FFR<0.80; 14 vs. 54). MACE was a composite of death/MI definitely/possibly related to a study lesion or TLR at 1-year. Events were adjudicated to any given lesion according to a “worse case scenario assumption”.
Total lesion-related MACE was 3.7% in ACS vs. 3.9% in non-ACS, due to an excess TLR in stable CAD pts (death/MI 2.4% vs. 0.9%; p=0.03). Event rates increased stepwise in both subgroups across management strategies, with the lowest incidences in Group 1 (Figure 1). Rates of Death/MI definitely/possibly related to a study lesion were similar in both ACS and non-ACS lesions deferred with an FFR>0.80. Ischemia-driven TLR was low in Group 1-ACS and comparable to non-ACS (1.5% vs. 2.3%; p=0.6). In all differed lesions (groups 1 & 3), FFR was an independent predictor of TLR (HR 0.002 per unit increase; 95% CI 0.0-0.31; p=0.016) and of death/MI alone (HR 4.0 for FFR<0.80; 95% CI 1.6-9.8; p=0.002).
Integration of FFR on management decisions of patients sustaining an acute NSTE-ACS or a recent ACS is safe. The outcome of deferring lesions with an FFR>0.80 was favorable in this setting and, in this cohort, as good as in non-ACS lesions.
IMAGING: FFR and Physiologic Lesion Assessment