Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May;120(6):e20211051.
doi: 10.36660/abc.20211051.

Prognostic Assessment of Fractional Flow Reserve in Different Strata in Patients with Coronary Artery Disease

[Article in English, Portuguese]
Denise Pellegrini  1 , Paulo R A Caramori  2 , Ricardo Czarnobai Soccol  2 , Ricardo Lasevitch  2 , Gustavo Luís Agostini  2 , Alice Dussin  1 , Flavio Vinicius Costa Ferreira  2 , Mario Bernardes Wagner  1 , Luiz Carlos Bodanese  2
Affiliations

Prognostic Assessment of Fractional Flow Reserve in Different Strata in Patients with Coronary Artery Disease

[Article in English, Portuguese]
Denise Pellegrini et al. Arq Bras Cardiol. 2023 May.

Abstract
in English, Portuguese

Background: There are limited real-world data on the clinical course of untreated coronary lesions according to their functional severity.

Objective: To evaluate the 5-year clinical outcomes of patients with revascularized lesions with fractional flow reserve (FFR) ≤ 0.8 and patients with non-revascularized lesions with FFR > 0.8.

Methods: The FFR assessment was performed in 218 patients followed for up to 5 years. Participants were classified based on FFR into ischemia group (≤ 0.8, intervention group, n = 55), low-normal FFR group (> 0.8-0.9, n = 91), and high-normal FFR group (> 0.9, n = 72). The primary endpoint was major adverse cardiac events (MACEs), a composite of death, myocardial infarction, and need for repeat revascularization. The significance level was set at 0.05; therefore, results with a p-value < 0.05 were considered statistically significant.

Results: Most patients were male (62.8%) with a mean age of 64.1 years. Diabetes was present in 27%. On coronary angiography, the severity of stenosis was 62% in the ischemia group, 56.4% in the low-normal FFR group, and 54.3% in the high-normal FFR group (p<0.05). Mean follow-up was 3.5 years. The incidence of MACEs was 25.5%, 13.2%, and 11.1%, respectively (p=0.037). MACE incidence did not differ significantly between the low-normal and high-normal FFR groups.

Conclusion: Patients with FFR indicative of ischemia had poorer outcomes than those in non-ischemia groups. There was no difference in the incidence of events between the low-normal and high-normal FFR groups. Long-term studies with a large sample size are needed to better assess cardiovascular outcomes in patients with moderate coronary stenosis with FFR values between 0.8 and 1.0.

Fundamento: Existem dados limitados sobre a evolução clínica de lesões coronarianas não tratadas de acordo com sua gravidade funcional no mundo real.

Objetivo: Este estudo teve como objetivo avaliar os resultados clínicos de até 5 anos em pacientes com lesões revascularizadas com reserva de fluxo fracionada (FFR) ≤ 0,8 e em pacientes com lesões não revascularizadas com FFR > 0,8.

Métodos: A avaliação pelo FFR foi realizada em 218 pacientes seguidos por até 5 anos. Os participantes foram classificados com base na FFR no grupo isquêmico (≤ 0,8, grupo intervenção, n = 55), no grupo FFR normal-baixa (> 0,8-0,9, n = 91) e no grupo FFR normal-alta (> 0,9, n = 72). O desfecho primário foram eventos cardíacos adversos maiores (ECAMs), um composto de morte, infarto do miocárdio e necessidade de nova revascularização. O nível de significância adotado neste estudo foi alfa = 0,05; deste modo, resultados com valores de p < 0,05 foram considerados estatisticamente significativos.

Resultados: A maioria dos participantes era do sexo masculino (62,8%) com média de idade de 64,1 anos. Diabetes estava presente em 27%. À angiografia coronariana, a gravidade da estenose avaliada foi de 62%, 56,4% e 54,3% nos grupos isquêmico, FFR normal-baixa e FFR normal-alta, respectivamente (p < 0,05). O período médio de acompanhamento foi de 3,5 anos. A incidência ECAM foi de 25,5%, 13,2% e 11,1%, respectivamente (p = 0,037). Não houve diferença na incidência de ECAM entre os grupos FFR normal-baixa e FFR normal-alta (p = NS).

Conclusão: Pacientes com FFR indicativa de isquemia apresentaram piores desfechos quando comparados aos dos grupos não isquêmicos. Entre os grupos que apresentaram valores de FFR considerados normal-baixo e normal-alto, não houve diferença na incidência de eventos. Há necessidade de estudos de longo prazo e com grande número de pacientes para melhor avaliar os desfechos cardiovasculares em pacientes portadores de estenose coronariana moderada com valores de FFR entre 0,8 e 1,0.

PubMed Disclaimer

Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo

Figures

Figura Central
Figura Central. : Avaliação Prognóstica da Reserva de Fluxo Fracionada em Diferentes Estratos nos Pacientes com Doença Arterial Coronariana
Figura 1
Figura 1. – Comparação de eventos cardíacos adversos maiores (ECAMs) entre os grupos.
Central Illustration
Central Illustration. : Prognostic Assessment of Fractional Flow Reserve in Different Strata in Patients with Coronary Artery Disease
Figure 1
Figure 1. – Between-group comparison of MACEs. FFR: fractional flow reserve.
See this image and copyright information in PMC

References

    1. Kogame N, Ono M, Kawashima H, Tomaniak M, Hara H, Leipsic J, et al. The Impact of Coronary Physiology on Contemporary Clinical Decision Making. JACC Cardiovasc Interv. 2020;13(14):1617–1638. doi: 10.1016/j.jcin.2020.04.040. - DOI - PubMed
    1. Burggraf GW, Parker JO. Prognosis in Coronary Artery Disease. Angiographic, Hemodynamic, and Clinical Factors. Circulation. 1975;51(1):146–156. doi: 10.1161/01.cir.51.1.146. - DOI - PubMed
    1. Stone GW, Maehara A, Lansky AJ, De Bruyne B, Cristea E, Mintz GS, et al. A Prospective Natural-History Study of Coronary Atherosclerosis. N Engl J Med. 2011;364(3):226–235. doi: 10.1056/NEJMoa1002358. - DOI - PubMed
    1. Yun KH, Mintz GS, Farhat N, Marso SP, Taglieri N, Verheye S, et al. Relation between Angiographic Lesion Severity, Vulnerable Plaque Morphology and Future Adverse Cardiac Events (from the Providing Regional Observations to Study Predictors of Events in the Coronary Tree study) Am J Cardiol. 2012;110(4):471–477. doi: 10.1016/j.amjcard.2012.04.018. - DOI - PubMed
    1. Mangiacapra F, Bressi E, Sticchi A, Morisco C, Barbato E. Fractional Flow Reserve (FFR) as a Guide to Treat Coronary Artery Disease. Expert Rev Cardiovasc Ther. 2018;16(7):465–477. doi: 10.1080/14779072.2018.1489236. - DOI - PubMed