Home > Uncategorized > Multivessel FFR and Prognosis

Multivessel FFR and Prognosis

Lee et at (European Heart Journal (2017) 00, 1–8 CLINICAL RESEARCH
doi:10.1093/eurheartj/ehx458)  report on the relationship between total atherosclerotic physiological burden as assessed by multivessel FFR and 2 year cardiac event rates.

ABSTRACT

Aims

There are limited data on the clinical implications of total physiologic atherosclerotic burden assessed by invasive
physiologic studies in patients with coronary artery disease. We investigated the prognostic implications of total physiologic atherosclerotic burden assessed by total sum of fractional flow reserve (FFR) in three vessels (3V-FFR).

Methods and results

A total of 1136 patients underwent FFR measurement in three vessels (3V FFR-FRIENDS study, NCT01621438). The patients were classified into high and low 3V-FFR groups according to the median value of 3V-FFR (2.72). Theprimary endpoint was major adverse cardiac events (MACE, a composite of cardiac death, myocardial infarction and ischaemia-driven revascularization) at 2 years. Mean angiographic percent diameter stenosis and FFR were 43.7 ± 19.3% and 0.90 ± 0.08, respectively. There was a negative correlation between 3V-FFR and estimated 2-year MACE rate (P < 0.001). The patients in low 3V-FFR group showed a higher risk of 2-year MACE than those in the high 3V-FFR group [(7.1% vs. 3.8%, hazard ratio (HR) 2.205, 95% confidence interval (CI) 1.201–4.048, P = 0.011]. The higher 2-year MACE rate was mainly driven by the higher rate of ischaemia-driven revascularization in the low 3V-FFR group (6.2% vs. 2.7%, HR 2.568, 95% CI 1.283–5.140, P = 0.008). In a multivariable adjusted model, low 3VFFR was an independent predictor of MACE (HR 2.031, 95% CI 1.078–3.830, P = 0.029).

Conclusion

Patients with high total physiologic atherosclerotic burden assessed by 3V-FFR showed higher risk of 2-year clinical events than those with low total physiologic atherosclerotic burden. The difference was mainly driven by
ischaemia-driven revascularization for both functionally significant and insignificant lesions at baseline. Three-vessel FFR might be used as a prognostic indicator in patients with coronary artery disease.

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