title: Usefulness of fractional flow reserve measurements to defer revascularization in patients with stable or unstable angina pectoris, non-ST-elevation and ST-elevation acute myocardial infarction, or atypical chest pain.
abstract: This study determined the safety of deferring coronary revascularization based on a fractional flow reserve (FFR) value > or = 0.75 in a series of consecutive unselected coronary patients with moderate coronary lesions, including patients with unstable angina, myocardial infarction (MI), and/or positive noninvasive test findings. The study included 201 consecutive coronary patients (mean age 62 +/- 10 years; 65% men) with 231 lesions evaluated by FFR measurement for which revascularization was deferred based on a FFR value > or = 0.75. Lesions associated with a positive noninvasive test result were those located in an artery supplying a myocardial territory in which myocardial ischemia was demonstrated by a noninvasive test. Cardiac events (cardiac death, MI, revascularization) and Canadian Cardiovascular Society angina class were evaluated at follow-up. Indications for coronary angiography included unstable angina or MI (62%), stable angina (30%), or atypical chest pain (8%). Forty-four patients (22%) had > or = 1 coronary lesion associated with a positive noninvasive test result in which FFR was evaluated. Mean FFR value was 0.87 +/- 0.06 and mean lesion percent diameter stenosis was 41 +/- 8%. At 11 +/- 6 months of follow-up, cardiac events occurred in 20 patients (10%), and no significant differences were observed between patients with unstable angina or MI and those with stable angina (9% vs 13%, p = 0.44) or between patients with and without lesions associated with positive noninvasive test results (9% vs 10%, p = 1.00). At the end of follow-up, 88% of patients were asymptomatic in angina class 0 or I, with no differences across various groups. In conclusion, these results suggest that patients with moderate coronary lesions can be safely managed without revascularization on the basis of FFR measurements, irrespective of clinical presentation and/or presence of positive noninvasive test results.
authors.affiliation: Interventional Cardiology Laboratory, Quebec Heart Institute-Laval Hospital, Quebec, Quebec, Canada.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Potvin
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.forename: Onil
authors.initials: O
authors.lastname: Gleeton
authors.forename: Can Nanh
authors.initials: CN
authors.lastname: Nguyen
authors.forename: Gerald
authors.initials: G
authors.lastname: Barbeau
authors.forename: Guy
authors.initials: G
authors.lastname: Proulx
authors.forename: Robert
authors.initials: R
authors.lastname: De Larochellière
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Déry
authors.forename: Nuria
authors.initials: N
authors.lastname: Batalla
authors.forename: Ali
authors.initials: A
authors.lastname: Dana
authors.forename: Alvaro
authors.initials: A
authors.lastname: Facta
authors.forename: Louis
authors.initials: L
authors.lastname: Roy
mesh_terms: D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D001783:Blood Flow Velocity / Q000502:physiology*; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D009204:Myocardial Revascularization; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index