TY - JOUR
T1 - Combined Assessment of FFR and CFR for Decision Making in Coronary Revascularization
T2 - From the Multicenter International ILIAS Registry
AU - van de Hoef, Tim P.
AU - Lee, Joo Myung
AU - Boerhout, Coen K. M.
AU - de Waard, Guus A.
AU - Jung, Ji-Hyun
AU - Lee, Seung Hun
AU - Mejía-Rentería, Hernán
AU - Hoshino, Masahiro
AU - Echavarria-Pinto, Mauro
AU - Meuwissen, Martijn
AU - Matsuo, Hitoshi
AU - Madera-Cambero, Maribel
AU - Eftekhari, Ashkan
AU - Effat, Mohamed A.
AU - Murai, Tadashi
AU - Marques, Koen
AU - Doh, Joon-Hyung
AU - Christiansen, Evald H.
AU - Banerjee, Rupak
AU - Nam, Chang-Wook
AU - Niccoli, Giampaolo
AU - Nakayama, Masafumi
AU - Tanaka, Nobuhiro
AU - Shin, Eun-Seok
AU - van Royen, Niels
AU - Chamuleau, Steven A. J.
AU - Knaapen, Paul
AU - Escaned, Javier
AU - Kakuta, Tsunekazu
AU - Koo, Bon Kwon
AU - Piek, Jan J.
N1 - Funding Information: Dr van de Hoef has received speaker fees and institutional research grants from Abbott and Philips. Dr J.M. Lee has received research grants from Abbott and Philips. Dr Echavarria-Pinto has received speaker fees from Abbott and Philips. Dr van Royen has received speaker fees and institutional research grants from Abbott and Philips. Dr Escaned is a speaker and consultant for Abbott, Boston Scientific, and Philips; and has received personal fees from Philips, Boston Scientific, and Abbott/St. Jude Medical outside the submitted work. Dr Koo has received institutional research grants from Abbott Vascular and Philips Volcano. Dr Piek has received support as a consultant for Philips/Volcano; and has received institutional research grants from Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: In vessels in which both FFR and CFR were low but revascularization was deferred, 5-year TVF rates were significantly higher than in revascularized vessels, supporting a clinical relevance of revascularization in vessels with such severely disrupted coronary hemodynamics. These data are important in light of the results of the ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) and ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trials.17,18 The data from ORBITA, ISCHEMIA, and FAME II document that a restrictive approach to coronary revascularization is safe and does not lead to impaired clinical outcomes and that an FFR-guided strategy improves but does not optimize patient selection for revascularization. With the use of CFR as a complementary diagnostic technique, the data from the ILIAS registry suggest that lesions with low FFR and low CFR benefit most from revascularization, as their deferral is associated with events rates that are significantly higher than those observed after coronary revascularization. As such, our findings support the hypothesis that combined FFR and CFR assessment allows to enhance the identification of patients in whom the risk/benefit ratio favors revascularization over medical therapy for the prevention of future adverse events. These data further support the development of a randomized trial evaluating the safety and cost efficacy of a combined FFR- and CFR-guided intervention strategy in comparison with an FFR-guided strategy to further inform clinical practice regarding optimizing lesion selection for revascularization. Publisher Copyright: © 2022 American College of Cardiology Foundation
PY - 2022/5/23
Y1 - 2022/5/23
N2 - Objectives: The aim of this study was to demonstrate the clinical implications of combined assessment of fractional flow reserve (FFR) and coronary flow reserve (CFR). Background: Combined assessment of FFR and CFR allows detailed characterization of pathophysiology in chronic coronary syndromes. Data on the clinical implications of distinct FFR and CFR patterns are limited, leading to uncertainty regarding their relevance. Methods: Patients with chronic coronary syndromes and obstructive coronary artery disease were selected from the multicenter ILIAS (Inclusive Invasive Physiological Assessment in Angina Syndromes) registry. Patients were classified into 4 groups on the basis of FFR ≤0.80 and CFR <2.0. The endpoint was the 5-year target vessel failure (TVF) rate. Results: A total of 2,143 patients with 2,725 lesions were included. Compared with normal FFR/normal CFR, low FFR/low CFR carried the highest risk for TVF (HR: 5.4; 95% CI: 3.2-9.3; P < 0.001), significantly higher than in revascularized vessels (P = 0.007). Discordance, with either low FFR/normal CFR or normal FFR/low CFR, was associated with increased TVF rates compared with normal FFR/normal CFR (low FFR/normal CFR: HR: 3.5 [95% CI: 2.2-5.4; P < 0.001]; normal FFR/low CFR: HR: 3.0 [95% CI: 1.9-4.7; P < 0.001]). No difference in 5-year TVF was observed between the 2 discordant groups (P = 0.57) or between the discordant groups and the revascularized group (P = 0.26 vs low FFR/normal CFR; P = 0.60 vs normal FFR/low CFR). Conclusions: Impaired coronary hemodynamics are uniformly associated with increased 5-year TVF rates. Nonrevascularized vessels with discordant FFR and CFR are associated with 5-year event rates that are equivalent to those of vessels that undergo revascularization, whereas vessels with combined low FFR and CFR exhibit event rates that are significantly higher than after revascularization. (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry [ILIAS Registry]; NCT04485234)
AB - Objectives: The aim of this study was to demonstrate the clinical implications of combined assessment of fractional flow reserve (FFR) and coronary flow reserve (CFR). Background: Combined assessment of FFR and CFR allows detailed characterization of pathophysiology in chronic coronary syndromes. Data on the clinical implications of distinct FFR and CFR patterns are limited, leading to uncertainty regarding their relevance. Methods: Patients with chronic coronary syndromes and obstructive coronary artery disease were selected from the multicenter ILIAS (Inclusive Invasive Physiological Assessment in Angina Syndromes) registry. Patients were classified into 4 groups on the basis of FFR ≤0.80 and CFR <2.0. The endpoint was the 5-year target vessel failure (TVF) rate. Results: A total of 2,143 patients with 2,725 lesions were included. Compared with normal FFR/normal CFR, low FFR/low CFR carried the highest risk for TVF (HR: 5.4; 95% CI: 3.2-9.3; P < 0.001), significantly higher than in revascularized vessels (P = 0.007). Discordance, with either low FFR/normal CFR or normal FFR/low CFR, was associated with increased TVF rates compared with normal FFR/normal CFR (low FFR/normal CFR: HR: 3.5 [95% CI: 2.2-5.4; P < 0.001]; normal FFR/low CFR: HR: 3.0 [95% CI: 1.9-4.7; P < 0.001]). No difference in 5-year TVF was observed between the 2 discordant groups (P = 0.57) or between the discordant groups and the revascularized group (P = 0.26 vs low FFR/normal CFR; P = 0.60 vs normal FFR/low CFR). Conclusions: Impaired coronary hemodynamics are uniformly associated with increased 5-year TVF rates. Nonrevascularized vessels with discordant FFR and CFR are associated with 5-year event rates that are equivalent to those of vessels that undergo revascularization, whereas vessels with combined low FFR and CFR exhibit event rates that are significantly higher than after revascularization. (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry [ILIAS Registry]; NCT04485234)
KW - coronary flow reserve
KW - fractional flow reserve
KW - percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=85129751625&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcin.2022.03.016
DO - https://doi.org/10.1016/j.jcin.2022.03.016
M3 - Article
C2 - 35589234
SN - 1936-8798
VL - 15
SP - 1047
EP - 1056
JO - JACC. Cardiovascular interventions
JF - JACC. Cardiovascular interventions
IS - 10
ER -