Author + information
- Marco Arena1,
- Roberto Gistri2,
- Giorgio Caretta1,
- Giorgio Tonelli3,
- Anees Al Jabri4 and
- Veronica Scardigli1
To assess the role of Fractional Flow Reserve (FFR) in stratifying cardiovascular risk in patients (pts) with non-ST elevation acute myocardial infarction (NSTEMI) referred for invasive management.
Out of 2728 pts undergoing coronary angiography from Jan 2011 to Dec 2013, we retrospectively studied 150 pts that presented with a diagnosis of NSTEMI and consecutively underwent FFR-guided revascularization. Clinically indicated culprit lesions were revascularized without FFR measurement followed by FFR evaluation of the other stenosis. The FFR cut-off was 0.80. On the basis of FFR results, we compared two patient groups: those with all lesions ≥0.80 (“defer group”, n=87, 58%) and those with at least one lesion <0.80 (“perform group”, n=63, 42%). The primary end-point was the composite of all-cause death, non-fatal myocardial infarction and unplanned revascularization.
Median clinical follow-up was 1059 days (IQR 425 – 1319). Overall incidences of adverse events at 1 and 3 years of follow-up were 15% and 27%, respectively. Event rates in the “defer” and “perform” groups were 14% and 30% at 1 year, and 26% and 44% at 3 years, respectively (log-rank test p=0.014). On univariable analysis, perform group, diabetes, previous myocardial infarction and chronic kidney failure (CKF) proved to be associated with a higher risk of adverse events. After multivariable adjustment, CKF (HR 3.50, 95% CI: 1.89 – 6.46, p=0.0001) and FFR group (“perform” vs ”defer”: HR 1.75 95% CI: 1.01 - 3.04, p=0.046) resulted independent predictors of adverse events.
FFR predicts long-term cardiovascular outcome among NSTEMI pts referred for cardiac catheterization. Pts without functionally significant coronary disease constitute a subset at lower risk of cardiac events.
IMAGING: FFR and Physiologic Lesion Assessment