Fractional flow reserve assessment for guiding the strategy of endovascular treatment of patients with chronic coronary syndrome and multivessel coronary artery disease

Vartanyan E.L.: Medical Research and Educational Center, Moscow State University, Moscow, Russia

Polyakov R.S.: Medical Research and Educational Center, Moscow State University, Moscow, Russia

Dyachuk L.I.: Medical Research and Educational Center, Moscow State University, Moscow, Russia

Fetzer D.V.: Medical Research and Educational Center, Moscow State University, Moscow, Russia

Arutyunova Ya.E.: Medical Research and Educational Center, Moscow State University, Moscow, Russia

Karanadze N.A.: Medical Research and Educational Center, Moscow State University, Moscow, Russia

Trukhanova M.A.: Medical Research and Educational Center, Moscow State University, Moscow, Russia

Mironov N.A.: Medical Research and Educational Center, Moscow State University, Moscow, Russia

Matskeplishvili S.T.: Medical Research and Educational Center, Moscow State University, Moscow, Russia

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Summary

Aim

To evaluate the impact of fractional flow reserve (FFR) assessment on the choice of the myocardial revascularization strategy in patients with ischemic heart disease and multivessel coronary artery disease and to compare the long-term outcomes of complete functional or anatomical revascularization.

Material and methods

We recruited 163 patients with chronic coronary syndrome and multivessel coronary artery disease who were distributed into two groups. Forty five patients from the study group underwent FFR guided percutaneous coronary intervention (PCI), whereas 118 patients from the control group underwent PCI with complete anatomical revascularization. The primary endpoint was defined as a combination of non-fatal myocardial infarction, repeated revascularization or death from all causes at 12 month of follow-up, whereas the secondary endpoints were the components of the primary endpoint.

Results

In 25 (55.6%) patients from the study group, the initially planned strategy of myocardial revascularization was changed after FFR measurement. In 18 cases, angiographically significant coronary artery lesion turned out to be functionally non-significant. Therefore, angioplasty of the respective artery was not required. The immediate results of revascularisation were similar in the two groups. However, the average number of implanted stents per patient in the complete functional revascularization group was significantly lower than in the complete anatomical revascularization group (1.76±0.57 vs. 2.29±0.54, р<0.0001). At 12 months, the combined rate of major adverse cardiac events was low and comparable between the two groups.

Conclusion

FFR assessment resulted in modification of the initially planned strategy of myocardial revascularization in more than half of patients with chronic coronary syndrome and multivessel coronary artery disease and was associated with a lower number of implanted stents per patient without an increase in the risk of major adverse cardiac events over 12 months follow up.

Key words

Chronic coronary syndrome, multivessel coronary artery disease, revascularization, fractional flow reserve.