Untreated Lesions After Fractional Flow Reserve-Guided PCI

Study Questions:

What is the impact of residual angiographic disease in patients undergoing fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI)?

Methods:

The FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) trial investigators assessed the impact of residual SYNTAX score in 427 patients who underwent FFR-guided PCI. The residual SYNTAX score was the SYNTAX score calculated at the end of PCI.

Results:

The baseline mean SYNTAX score was 14.4 and the residual score was 6.5. There were 53 (12%) major adverse cardiac events (MACE) on 1-year follow-up. The baseline SYNTAX score was higher in those with MACE at follow-up (18 vs. 12), but the residual SYNTAX score was similar (6 vs. 5).

Conclusions:

In patients undergoing functionally complete PCI, residual disease does not appear to be associated with worse outcome.

Perspective:

This study adds to the data supporting FFR for guiding completeness of revascularization in patients undergoing PCI, but the study sample is too small to rule out the prognostic importance of residual coronary artery disease. It is likely that the presence of residual disease is a marker of more diffuse and advanced coronary artery disease, and might impact long-term survival with extended follow-up. However, there are currently no data to treat these patients any differently compared with the guideline-recommended approach for all patients undergoing PCI.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Angiography, Coronary Artery Disease, Coronary Stenosis, Fractional Flow Reserve, Myocardial, Myocardial Revascularization, Percutaneous Coronary Intervention


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