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Recent developments in FFR helping refine revascularization strategies
Fractional flow reserve is an intervention tool which was designed to determine the existence and severity of myocardial ischemia in a coronary artery. It helps identify patients who can be deferred from revascularization, and can potentially reduce the number of PCIs performed.
Cardiology Today’s Intervention has compiled a list of articles covering the benefits and concerns from recent studies focusing on FFR, such as MR-INFORM, DEFINE-FLAIR, IFR-SWEDEHEART, COMPARE-ACUTE and many more.
MR-INFORM: MR-guided, FFR-guided strategies confer similar outcomes in stable angina
WASHINGTON — For initial management of patients with stable angina and intermediate to high risk for CAD, a noninvasive magnetic resonance perfusion imaging strategy was noninferior to an invasive strategy supported by FFR, according to results from the MR-INFORM study.
The MR-guided strategy was associated with fewer revascularization procedures compared with the FFR-guided strategy, Eike Nagel, MD, FACC, from University Hospital Frankfurt, Germany, said during a presentation at the American College of Cardiology Scientific Session.
iFR noninferior to FFR for revascularization in patients with stable angina, ACS
WASHINGTON — At 1 year, rates of MACE in patients who underwent revascularization guided by instantaneous wave-free ratio were comparable to those in patients who underwent revascularization guided by fractional flow reserve, according to data from two studies presented at the ACC Scientific Session.
Both studies — DEFINE-FLAIR and IFR-SWEDEHEART — enrolled patients with stable angina or ACS who were indicated for physiologically guided assessment of a coronary lesion. The primary endpoint in both studies was a composite of all-cause mortality, nonfatal MI or unplanned revascularization within 12 months after the procedure.
COMPARE-ACUTE: FFR-guided complete revascularization linked to lower risk for adverse events
WASHINGTON — In patients with STEMI and multivessel disease, complete revascularization guided by FFR was associated with reduced adverse events compared with PCI of an infarct-related artery only, according to data presented by Pieter Smits, MD, PhD.
“Approximately 50% of STEMI patients have multivessel disease at presentation,” Smits, of Maasstad Ziekenhuis in Rotterdam, the Netherlands, said during his presentation of the COMPARE-ACUTE results at the ACC Scientific Session. “What to do with these noninfarct-related artery lesions and when remain an unresolved clinical dilemma.”
Poststenting FFR predictive of 12-month restenosis in superficial femoral artery disease
In patients with superficial femoral artery disease, a poststenting mean FFR value of 0.92 or less appears to be the ideal threshold for predicting 12-month restenosis, according to recent findings.
In the prospective, single-center, nonrandomized study, researchers evaluated 48 patients (mean age, 76 years; 38 men) with 51 superficial femoral artery (SFA) lesions enrolled between July 2013 and June 2014. Eligible patients were symptomatic and had > 50% SFA stenosis.
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Mortality link with FFR questioned in FUTURE trial
NEW ORLEANS — The FUTURE trial, designed to evaluate the impact of therapeutic management guided by FFR or conventional angiography, was halted early due to an excess of all-cause mortality among patients who received the FFR strategy.
However, follow-up data on available patients enrolled before the study stopped showed a persistent but nonsignificant difference in all-cause mortality at 1 year between the two groups.