FFR measurements provide substantial value, help determine when patients need PCI

Letting single-vessel fractional flow reserve (FFR) measurements help guide the management of patients with coronary artery disease (CAD) leads to much better outcomes, according to findings published in JAMA.

While percutaneous coronary intervention (PCI) is typically recommended for ischemic FFR lesions, PCI is not recommended for nonischemic FFR lesions. The study’s authors explored five years of data to evaluate the effectiveness of these FFR measurements—and found that they can make a big difference.

The researchers tracked outcomes from more than 9,000 adult CAD patients who underwent coronary angiography from April 1, 2013, to March 31, 2018.  All patients were treated in Ontario, Canada. Patients were excluded if they received cardiac catheterization for aortic stenosis, congenital heart disease or cardiac transplants.

Overall, among patients with an ischemic FFR, 75.3% received PCI. Those patients had a much lower rate of major adverse cardiac events (MACEs) than patients with an ischemic FFR who did not receive PCI.

The myocardial infarction (MI) rate, for example, was 8.7% for patients who received PCI and 10.8% for those who did not. The mortality rate was 16.8% for PCI patients and 20.6% for patients who did not receive PCI.

Among patients with a nonischemic FFR, on the other hand, 12.6% still received PCI. Those patients had a much higher MACE rate than patients with a nonischemic FFR who did not receive PCI.

The MI rate was 18.6% among PCI patients and 12.7% among those who did not receive PCI.

“PCI, compared with no PCI, was significantly associated with better clinical outcomes in ischemic lesions and worse outcomes in nonischemic lesions,” wrote lead author Maneesh Sud, MD, of the University of Toronto, and colleagues. “These findings support the performance of PCI procedures according to evidence-based FFR thresholds.”

Sud et al. wrote that it is unclear why so many clinicians still chose to perform PCI for nonischemic lesions. They did, however, offer some potential explanations.

“First, because FFR is a continuous measurement with a continuous risk spectrum, clinicians may feel inclined to perform PCI at borderline FFR values,” the authors wrote. “Second, it is also possible that clinicians have a higher propensity to perform PCI among patients who have positive noninvasive stress tests or those with anginal symptoms despite a negative FFR. Regardless of the reason, this study suggests that deviating from accepted FFR thresholds is more common in routine clinical practice than previously reported from registries.”

The JAMA analysis is available here.