title: Outcome of coronary lesions with deferred revascularization due to negative fractional flow reserve in subjects with acute coronary syndrome.
abstract: OBJECTIVE
  Revascularization of functionally non-significant stenoses in patients with stable coronary artery disease can safely be deferred as rate of adverse cardiovascular events is low. It is not clear whether fractional flow reserve (FFR) is just as accurate in acute coronary syndromes (ACS). The aim of this study is to assess the outcome of coronary lesions whose revascularization was deferred based on negative FFR values in subjects with ACS.
  
  
  METHODS
  Patients with acute coronary syndrome and showing at least one coronary stenosis whose revascularization was deferred based on FFR value >0.80 were included in the study. The primary endpoint of the study was the rate of target lesion failure (TLF), a composite of cardiac events (cardiac death, myocardial infarction and any coronary revascularization) related to the initially deferred stenosis at three-year follow-up.
  
  
  RESULTS
  A total of 319 patients (237 male), mean age 68 [59-74] years and 355 coronary lesions with deferred revascularization based on negative FFR values (0.88±0.05) were selected. The rate of TLF was 6% at 1-year, 9% at 2-year and 12% at 3-year follow-up. TLF was driven by a new acute coronary syndrome in 75% of cases. The median time interval from FFR assessment to TLF was 457 [138-868] days.
  
  
  CONCLUSIONS
  In patients with acute coronary syndrome, the rate of TLF of the initially deferred coronary stenoses is 12% at 3-year follow-up and TLF occurred because of a new ACS in three quarters of cases.
authors.affiliation: Division of Cardiology, Misericordia Hospital, Grosseto, Italy. Electronic address: andre.picchi@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Picchi
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Zilio
authors.affiliation: Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Cerrato
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Department of Cardiology, University Medical Hospital of Siena, Siena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Fineschi
authors.affiliation: Division of Cardiology, Sandro Pertini Hospital, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rigattieri
authors.affiliation: Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ferlini
authors.affiliation: Department of Cardiology, University Medical Hospital of Siena, Siena, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cameli
authors.affiliation: Division of Cardiology, Misericordia Hospital, Grosseto, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabria
authors.affiliation: Division of Cardiology, Misericordia Hospital, Grosseto, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cresti
authors.affiliation: Division of Cardiology, Misericordia Hospital, Grosseto, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Limbruno
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000368:Aged; D017023:Coronary Angiography; 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*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Acute coronary syndrome; Coronary revascularization; Fractional flow reserve