Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Aug 2017)

Clinical Outcomes of Deferred Lesions With Angiographically Insignificant Stenosis But Low Fractional Flow Reserve

  • Joo Myung Lee,
  • Bon‐Kwon Koo,
  • Eun‐Seok Shin,
  • Chang‐Wook Nam,
  • Joon‐Hyung Doh,
  • Xinyang Hu,
  • Fei Ye,
  • Shaoliang Chen,
  • Junqing Yang,
  • Jiyan Chen,
  • Nobuhiro Tanaka,
  • Hiroyoshi Yokoi,
  • Hitoshi Matsuo,
  • Hiroaki Takashima,
  • Yasutsugu Shiono,
  • Doyeon Hwang,
  • Jonghanne Park,
  • Kyung‐Jin Kim,
  • Takashi Akasaka,
  • Jianan Wang

DOI
https://doi.org/10.1161/JAHA.117.006071
Journal volume & issue
Vol. 6, no. 8

Abstract

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BackgroundData are limited regarding outcomes of deferred lesions in patients with angiographically insignificant stenosis but low fractional flow reserve (FFR). We investigated the natural history of angiographically insignificant stenosis with low FFR among patients who underwent routine 3‐vessel FFR measurement. Methods and ResultsFrom December 2011 to March 2014, 1136 patients with 3298 vessels underwent routine 3‐vessel FFR measurement (3V FFR‐FRIENDS study, ClinicalTrials.gov identifier NCT01621438), and this study analyzed the 2‐year clinical outcomes of 1024 patients with 2124 lesions with angiographically insignificant stenosis (percentage of diameter stenosis 0.80 versus low FFR ≤0.80). The primary end point was outcome of major adverse cardiovascular events (a composite of cardiac death, myocardial infarction, and ischemia‐driven revascularization) at 2 years. Mean angiographic percentage of diameter stenosis and FFR of total lesions were 32.5±10.3% and 0.91±0.08%, respectively. Among the total lesions with angiographically insignificant stenosis, 8.7% showed low FFR (185 lesions). The incidence of lesions with low FFR was 2.5%, 3.8%, 9.0%, and 15.1% in categories of percentage of diameter stenosis <20%, 20% to 30%, 30% to 40%, and 40% to 50%, respectively. At 2‐year follow‐up, the low‐FFR group showed a significantly higher risk of major adverse cardiovascular events compared with the high FFR group (3.3% versus 1.2%, hazard ratio: 3.371; 95% CI, 1.346–8.442; P=0.009). In multivariable analysis, low FFR was the most powerful independent predictor of future MACE in deferred lesions with angiographically insignificant stenosis (adjusted hazard ratio: 2.617; 95% CI, 1.026–6.679; P=0.044). ConclusionsIn deferred angiographically insignificant stenosis, lesions with low FFR showed significantly higher event rates than those with high FFR. FFR was an independent predictor of future major adverse cardiovascular events in lesions with angiographically insignificant stenosis. Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01621438.

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