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Observational Study
. 2023 Aug;38(8):1009-1018.
doi: 10.1007/s00380-023-02256-7. Epub 2023 Apr 17.

Prognostic impact of fractional flow reserve measurements in patients with acute coronary syndromes: a subanalysis of the FLORIDA study

Teresa Gerhardt  1   2 , Barbara E Stähli  3 , Tanja K Rudolph  4 , Matthias Lutz  5   6 , Anne-Sophie Schatz  1 , Lukas Zanders  1   7   8 , Tino Schubert  9 , Magnus Stueve  10 , Nick E J West  10 , Els Boone  10 , Ulf Landmesser  1   2 , David M Leistner  11   12   13   14
Affiliations
Observational Study

Prognostic impact of fractional flow reserve measurements in patients with acute coronary syndromes: a subanalysis of the FLORIDA study

Teresa Gerhardt et al. Heart Vessels. 2023 Aug.

Abstract

Randomized trials suggest benefits for fractional flow reserve (FFR)-guided vs. angiography-guided treatment strategies in well-defined and selected patient cohorts with acute coronary syndromes (ACS). The long-term prognostic value of FFR measurement in unselected all-comer ACS patients, however, remains unknown. This subanalysis of the Fractional FLOw Reserve In cardiovascular DiseAses (FLORIDA) study sought to investigate the long-term effects of FFR in the management of lesions in patients with acute coronary syndrome (ACS). FLORIDA was an observational all-comer cohort study performed in Germany, that was population-based and unselected. Patients enrolled into the anonymized InGef Research Database presenting with ACS and undergoing coronary angiography between January 2014 and December 2015 were included in the analysis. Patients were stratified into either the FFR-guided or the angiography-guided treatment arm, based on the treatment received. A matched cohort study design was used. The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiovascular events (MACE), a composite of death, non-fatal myocardial infarction (MI), and repeat revascularization. Follow-up time was 3 years. Rates of 3-year mortality were 10.2 and 14.0% in the FFR-guided and the angiography-guided treatment arms (p = 0.04), corresponding to a 27% relative risk reduction for FFR in ACS patients. Rates of MACE were similar in both arms (47.7 vs. 51.5%, p = 0.14), including similar rates of non-fatal MI (27.7 vs. 25.4%, p = 0.47) and revascularization (9.9 vs. 12.1%, p = 0.17). In this large, all-comer observational study of ACS patients, FFR-guided revascularization was associated with a lower mortality at 3 years. This finding encourages the routine use of FFR to guide lesion revascularization in patients presenting with ACS.

Keywords: Acute coronary syndrome; Fractional flow reserve; Long-term follow-up; Prognosis; Unselected.

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Conflict of interest statement

Teresa Gerhardt reports grants from DZHK (German Center for Cardiovascular Research) and the DGK (German Cardiac Society) outside the submitted work. Barbara E. Stähli has been supported by the H.H. Sheikh Khalifa bin Hamad Al-Thani Research Programme, and research grants to the institution from the OPO Foundation, the Iten-Kohaut Foundation, the German Center for Cardiovascular Research (DZHK), Boston Scientific, and Edwards Lifesciences outside the submitted work. B. S. has received consulting and speaker fees from Boston Scientific, Abbott Vascular, and MedAlliance. David M. Leistner reports personal fees and non-financial support from Abbott Vascular, during the conduct of the study; personal fees from Boston Scientific and grants from DZHK (German Center for Cardiovascular Research) outside the submitted work. Tanja Rudolph reports personal fees from Vulcano Philips, personal fees from Abbott Vascular outside the submitted work. Matthias Lutz reports grants, personal fees and other from Abbott Medical during the conduct of the study. Tino Schubert reports grants from Abbott Vascular during the conduct of the study and personal fees from Abbott Vascular, personal fees from B. Braun and personal fees from Boston Scientific, outside the submitted work; Magnus Stueve, Nick E.J. West and Els Boone are employees of Abbott Vascular. Ulf Landmesser reports personal fees from Abbott, personal fees from Boston Scientific, personal fees from Biotronik, outside the submitted work. Imke J. Wuerdemann, Lukas Zanders and Anne-Sophie Schatz have nothing to disclose.

Figures

Fig. 1
Fig. 1
Flow diagram of the study. All patients presenting with ACS who received at least one angiography were included. Patients were matched for sex, age ± 5 years, and estimated propensity scores, with each patient in the FFR-guided treatment group matched to the closest patient in the angiography-guided treatment group. ACS acute coronary syndrome, CCS chronic coronary syndrome, FFR fractional flow reserve, n number
Fig. 2
Fig. 2
MACE in ACS patients with FFR-guided vs. angiography-only management. a MACE-free survival, b survival, c survival free from non-fatal MI, and d survival free from non-MI-associated revascularization. FFR fractional flow reserve, MACE major adverse cardiovascular events, MI myocardial infarction
Fig. 3
Fig. 3
Rates of MACE at 3 years in pre-defined patient subgroups. FFR fractional flow reserve, MACE major adverse cardiovascular events, MI myocardial infarction, PCI percutaneous coronary intervention, OMT optimal medical therapy
See this image and copyright information in PMC

References

    1. Jernberg T, Hasvold P, Henriksson M, Hjelm H, Thuresson M, Janzon M. Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J. 2015;36:1163–1170. doi: 10.1093/eurheartj/ehu505. - DOI - PubMed
    1. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’t Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360:213-224 - PubMed
    1. De Bruyne B, Fearon WF, Pijls NH, Barbato E, Tonino P, Piroth Z, Jagic N, Mobius-Winckler S, Rioufol G, Witt N, Kala P, MacCarthy P, Engström T, Oldroyd K, Mavromatis K, Manoharan G, Verlee P, Frobert O, Curzen N, Johnson JB, Limacher A, Nüesch E, Jüni P. Fractional flow reserve-guided PCI for stable coronary artery disease. N Engl J Med. 2014;371:1208–1217. doi: 10.1056/NEJMoa1408758. - DOI - PubMed
    1. Xiu J, Chen G, Zheng H, Wang Y, Chen H, Liu X, Wu J, Bin J. Comparing treatment outcomes of fractional flow reserve-guided and angiography-guided percutaneous coronary intervention in patients with multi-vessel coronary artery diseases: a systematic review and meta-analysis. Clin Invest Med. 2016;39:E25–36. doi: 10.25011/cim.v39i1.26327. - DOI - PubMed
    1. Zhang D, Lv S, Song X, Yuan F, Xu F, Zhang M, Yan S, Cao X. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention: a meta-analysis. Heart. 2015;101:455–462. doi: 10.1136/heartjnl-2014-306578. - DOI - PMC - PubMed

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