A study published in the Journal of the American College of Cardiology: Cardiovascular Interventions suggests that fractional flow reserve (FFR) may be safely used to guide treatment in patients with an intermediate LAD stenosis.
Olivier Muller and colleagues report on 730 patients at a single center in Belgium who had a 30%-70% stenosis in the proximal segment of the LAD who received treatment based on FFR. 564 patients who had an FFR >0.80 were treated medically, while 166 patients with an FFR <0.80 underwent revascularization. In the revascularization group, 13% underwent surgery and 87% underwent PCI.
The estimate of 5 year survival was 92.9% in the medical group and 87.4% in the revascularization group (p=0.03). The estimate of 5 year survival free of death, MI, and TVR was 89.7% in the medical group and 68.5% in the revascularization group (p<0.0001).
The authors wrote that their “study indicates that patients with an angiographically dubious, but hemodynamically nonsignificant, isolated stenosis in the proximal LAD (as assessed in the catheterization laboratory by FFR measurements) have a favorable long-term outcome without mechanical revascularization.” They note that although current recommendations call for functional testing to demonstrate ischemia prior to revascularization, a number of common factors “in daily practice” mean that this recommendation is frequently overlooked. As an alternative, “FFR makes it possible to obtain both anatomic and functional data during the same examination.”
The study, they conclude, “supports the strategy of deciding about revascularization based on both anatomic and functional information obtained simultaneously in the catheterization laboratory.”