Long-Term Patient-Related and Lesion-Related Outcomes After Real-World Fractional Flow Reserve Use.
BACKGROUND
Long-term clinical outcomes of real-world use of fractional flow reserve (FFR), including the decisions against FFR, have not been fully evaluated in the era of drug-eluting stent (DES) implantation.


METHODS
A total of 1294 patients who underwent FFR measurement for de novo coronary lesions were included. FFR measured lesions (n = 1628) were divided into FFR-defer or FFR-stent lesions according to the treatment strategy selected after FFR measurement. Clinical outcomes were assessed by patient-related major adverse cardiac event (a composite of all-cause death, myocardial infarction, and any revascularization) and target-lesion related event (target-lesion related myocardial infarction and revascularization).


RESULTS
Mean FFR was 0.80 ± 0.12, and FFR was ≤0.8 in 728 lesions (44.7%). Five-year cumulative all-death rate was 6.3%, myocardial infarction rate was 1.5%, and rate of any revascularization was 12.5%. Among 797 deferred lesions, 105 lesions had FFR ≤0.8 and those lesions had a higher risk of 5-year target-lesion related events than the lesions with FFR >0.8 (21.2% vs 6.6%, respectively; P=.03). By multivariate analyses, the determinant for the 1-year target-lesion related events was the presence of diabetes (hazard ratio, 3.74; 95% confidence interval, 1.45-9.67; P=.01), while the determinant for delayed events at 1-5 years was FFR ≤0.8 (hazard ratio, 4.50; 95% confidence interval, 1.65-12.28; P=.01). Angiographic lesion severity was not an independent predictor for clinical events during follow-up among deferred lesions.


CONCLUSIONS
The deferral of stenting according to FFR was associated with favorable long-term outcomes. Presence of diabetes and low FFR (≤0.8) increased the risk of clinical events in deferred lesions.
Joon-Hyung
JH
Doh
Chang-Wook
CW
Nam
Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744 Korea. bkkoo@snu.ac.kr.
Bon-Kwon
BK
Koo
Sang Hyun
SH
Park
Ju-Hee
JH
Lee
Jung-Kyu
JK
Han
Hyoung-Mo
HM
Yang
Hong-Seok
HS
Lim
Myeong-Ho
MH
Yoon
Yun-Kyeong
YK
Cho
Seung-Ho
SH
Hur
Sung Yun
SY
Lee
Hyo-Soo
HS
Kim
Seung-Jea
SJ
Tahk
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002423:Cause of Death; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D063868:Patient Outcome Assessment; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D015607:Stents