Clinical and functional outcome of fractional flow reserve guided management of triple vessel coronary artery disease

Abstract

Background: Fractional Flow Reserve (FFR) helps to assess the functional significance of a coronary stenosis accurately, particularly in triple vessel disease (TVD) where other modalities are ineffectual. There is dearth of data using FFR in TVD. In this study, we assessed outcome of FFR guided management in a spectrum of TVD.

Methods: A prospective observational study was conducted at four tertiary care hospitals of the armed forces between Aug 2019 and Aug 2023. Patients diagnosed with intermediate TVD on coronary angiogram (CAG) were included in the study. Initial treatment strategy based on CAG was noted. Treatment was reformulated based on FFR findings. Primary end points of death, myocardial infarction, repeat revascularization and stroke were evaluated at 3, 6 and 12 months.

Results: 145 patients were studied. 60 % presented with acute coronary syndrome (ACS). None of the mild stenosis (30-50 %) were found to be FFR positive in any of the vessels. 4.8 % lesions in LAD, 6.2 % lesions in LCx and 2.8 % lesions in RCA were found to be functionally non-significant despite having >70 % stenosis. Post FFR treatment variation was seen in 8.3 % in PCI group and surgery was averted in 33.3 % of CABG group. All-cause mortality was 3.5 %, 1.4 % had stroke and 1.4 % of patients required repeat revascularization. 83.5 % of all patients remained asymptomatic post intervention at 12 months follow-up.

Conclusions: FFR guided management lead to change of plan in a substantial 15.2 % of patients when compared to CAG based management. FFR negativity in LAD was the main reason for majority of TVD patients ending up with PCI instead of CABG.

Keywords: Coronary artery bypass graft; Coronary artery disease; Fractional flow reserve; Intermediate coronary stenosis; Percutaneous coronary intervention; Triple vessel disease.