Abstract
Background: Fractional flow reserve (FFR) guided coronary intervention has gained recognition in assessment and management for stable angina however its utility in ACS patients remains uncertain. Objective: To evaluate the safety and efficacy of FFR guided treatment in angiographically-determined moderate-lesions (typically luminal stenosis 50-70%) in ACS/stable angina patients. Methods: A single-centre, retrospective analysis of all patients undergoing FFR over an 8-year period (2011-2019). Demographics, angiographic findings, management strategy and one- and twelve-month outcome data were assessed and compared for haemodynamically significant (FFR ≤ 0.8) versus non-significant lesions (FFR > 0.8). The primary end-point was a composite of major adverse cardiac events (MACE) including myocardial infarction (MI), unplanned revascularisation, readmission for heart failure and all-cause mortality. Results: FFR was performed in 120 patients on 154 lesions during the study period, of which 26% presented with ACS. The average age was 66.5 years and 67% were male. 48/154 lesions (31%) were considered haemodynamically significant, of which 42 (88%) underwent immediate or semi-urgent revascularisation. No statistically significant differences were detected for the outcome or safety data of the two groups. At 12-months 8.7% of patients met the primary outcome for the haemodynamically significant group vs 10.8% for the non-significant group (p-value = 0.71). There was a non-significant trend was towards unplanned revascularisation at 12 months in the FFR > 0.8 group (6.8% vs 2.2%, p = 0.26), however none of these patients suffered MI. Conclusion: Our data shows FFR guided intervention for moderate coronary lesions, regardless of indication, is safe with no clinically significant differences in 12-month outcomes.
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