POST-IT: FFR changes patient management, identifies low-risk coronary lesions
Management strategy is safely changed in nearly half of patients with coronary lesions when routine fractional flow reserve is employed, according to new findings.
Routine FFR also accurately identified patients and lesions with a low likelihood of events in which revascularization can be safely deferred vs. those facing high risk when ischemic lesions go untreated, confirming results from previous randomized trials.
Management strategy was defined according to employment of medical therapy, revascularization or additional stress imaging. The researchers documented on a per-patient and per-lesion basis whether FFR results prompted changes from the initial to the final strategy.
Sergio Bravo Baptista, MD, from the cardiology department, Hospital Prof. Doutor Fernando Fonseca in Amadora, Portugal, and colleagues analyzed 1,293 lesions from a cohort of 918 patients (mean FFR, 0.81 ± 0.1) enrolled in the POST-IT study from March 2012 to November 2013.
All patients had at least one lesion evaluated using FFR. Patients were followed up for 12 months after the index procedure for MACE, defined as CV mortality, MI or unplanned revascularization.
The researchers found management plans changed for 406 patients (44.2%) and 584 lesions (45.2%). One-year MACE was 6.9%, and those in whom revascularization was deferred in all lesions had a lower MACE rate (5.3%) than those who had at least one lesion revascularized (7.3%) or not treated despite FFR of 0.8 or less (13.6%, log-rank P = .014).
Deferral of those with an FFR up to 0.8 was linked to a 3.1-fold rise in risk for CV death, MI or target lesion revascularization (P = .012). The researchers determined that proximal location of the lesion, B2/C type and FFR were independent predictors of TLR in the deferred lesions.
“FFR accurately identified patients (and lesions) with a low likelihood of events in which revascularization could be safely deferred as opposed to those at high risk when ischemic lesions are left untreated,” the researchers wrote. – by James Clark
Disclosure: The study was sponsored by an unrestricted investigational grant from St. Jude Medical. Baptista reports receiving consultant fees from St. Jude Medical. Two other researchers report receiving consultant fees from St. Jude Medical and Volcano.