Outcomes of coronary stenoses deferred revascularization for borderline versus nonborderline fractional flow reserve values.
Current evidence supports deferral of revascularization for lesions with fractional flow reserve (FFR) values >0.80. The natural history after deferral of revascularization of lesions with borderline FFR values is unknown. This study evaluated the outcomes of patients after deferred revascularization of coronary stenoses based on a borderline FFR value. We retrospectively studied 720 patients with 881 intermediate-severity coronary stenoses who underwent FFR assessment from October 2002 to July 2010 and were deferred revascularization. Patients were divided into gray zone (0.75 to 0.80), borderline (0.81 to 0.85), and nonborderline (>0.85) FFR groups. Any subsequent percutaneous coronary intervention or coronary artery bypass grafting of a deferred stenosis during follow-up was classified as a deferred lesion intervention (DLI). Patient and/or lesion characteristics and clinical outcomes were compared between the FFR groups using univariate and propensity score-adjusted inverse probability of weighting Cox proportional hazards analyses. During a mean follow-up of 4.5 ± 2.1 years, 157 deferred lesions (18%) underwent DLI by percutaneous coronary intervention (n = 117) or coronary artery bypass grafting (n = 40). No statistically significant differences were observed in clinical outcomes between the gray zone and borderline FFR groups. Lesions with a borderline FFR were associated with a significantly higher risk of DLI compared with lesions with nonborderline FFR values (hazard ratio 1.63, 95% confidence interval 1.14 to 2.33, p = 0.007). Lesions deferred revascularization because of a borderline FFR (0.81 to 0.85) were associated with a higher risk of DLI compared with lesions with a nonborderline FFR (>0.85). Further study is needed to determine the optimal management of coronary stenoses with a borderline FFR value.
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Jeremiah P
JP
Depta
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Jayendrakumar S
JS
Patel
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Eric
E
Novak
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Shriti K
SK
Masrani
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
David
D
Raymer
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Gabrielle
G
Facey
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Yogesh
Y
Patel
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Alan
A
Zajarias
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
John M
JM
Lasala
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Jasvindar
J
Singh
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Richard G
RG
Bach
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri. Electronic address: HURZ@dom.wustl.edu.
Howard I
HI
Kurz
D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome