Comparison of prognostic value of fractional flow reserve in deferred patients with normal FFR with normal FFR post-PCI patients with stable coronary artery disease

Background:
Deferring PCI based on non-ischemic FFR is associated with favorable long term outcomes in patients with stable ischemic heart disease (SIHD). Whether, normalized FFR after successful PCI in SIHD carries the same prognostic import is unknown.

Methods
The current study compared long-term major adverse cardiac events (MACE=target vascular revascularization, MI, and death) in SIHD patients deferred due to normal (0.80-0.99) FFR (n=362) and SIHD patients with normalized FFR (post-PCI FFR >0.8) after angiographically optimized PCI (n=326).

Results
Patients in the deferred FFR group were older (66.6+8 vs 64+ 8 yrs, p<0.001) and had increased incidence of CKD (25% vs 18%, p<0.03) but had similar incidence of diabetes (48.1% vs 46.1%), hypertension (96% vs 93.2%) and similar LV ejection fraction at baseline (50+12% vs 51+11%, p=0.10). FFR was slightly higher in post-PCI group [0.90±0.05 vs 0.88±0.06, p<0.001]. Follow-up was 36±18 months. There was no significant difference in MACE between the entire deferred and post-PCI patient groups (Figure 1a) or in subgroups above or below FFR of 0.9 (Figure 1b).

Conclusions
FFR value of > 0.8 post-PCI in patients with SIHD carries similar prognostic importance to that of deferred lesions.