Deferred revascularization safe with FFR guidance

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 - Fractional flow reserve
Fractional flow reserve is measured by placing a pressure guidewire across the lesion of interest and pharmacologically inducing hyperemia.
Source: St. Jude Medical

On the fence about deferring revascularization? A meta-analysis found similar rates of clinical outcomes when decisions for deferred revascularization in unprotected left main coronary artery stenosis were guided by fractional flow reserve (FFR).

Ultimately, however, patients who deferred revascularization were more than three times as likely to subsequently undergo revascularization.

Jaya Mallidi, MD, MHS, of the cardiology division at Baystate Medical Center in Springfield, Mass., and colleagues found that there were no randomized control trials to assess. However, six prospective cohort studies provided 525 pooled patients for their analysis of FFR-guided decisions. Revascularization occurred in 41 percent of patients, while 59 percent were deferred and treated with medical therapy. For most studies, the FFR cut-off was less than 0.75, although one study used a cut-off of 0.8 or less.

Composite endpoint of major cardiovascular events including death, MI and subsequent revascularization occurred in 19.4 percent of patients where revascularization was deferred and 14.2 percent of revascularized patients with no significant statistical differences reported between the two groups.

“Consistent with previous studies, which showed favorable clinical outcomes when using FFR in multi-vessel disease and stable coronary artery disease, our meta-analysis showed that FFR guided decision regarding revascularization can be extended safely to the evaluation of ambiguous LMCA [left main coronary artery] disease,” they wrote.

The meta-analysis was published online Feb. 11 in Catheterization and Cardiovascular Interventions.