Measurement, comparison, and application of FFR and non hyperemic Pd/Pa to estimate prognosis in non-culprit vessels of patients with acute coronary syndrome
Fülöp Gábor
Clinical Medicine
Dr. Reusz György
SE, Elméleti Orvostudományi Központ, Háry Pál terem
2023-06-05 20:23:05
Hormonal regulatory mechanisms
Dr. Rácz Károly
Piróth Zsolt
Dr. Zima Endre
dr. Komócsi András
Dr. Gellér László Alajos
Dr. Ábrahám Pál
Dr. Kónyi Attila
Functional assessment of coronary lesions has been extensively investigated and proved to be beneficial in chronic coronary syndrome. There is a recommendation from the guidelines to perform complete revascularization in ACS cases during the index hospitalization. Still, it is not completely clarified how to define significance of non-culprit lesions and how to safely defer intervention. It is possible to use plain coronary angiography, however that brings the possibility of under- or overestimation of the significance of lesions. If we use fractional flow reserve (FFR) in these non-culprit vessels then 30-50% of angiographically significant (diameter stenosis ≥50%) lesions will be reclassified functionally as causing no significant impairment to blood flow. Similarly, a high rate of functionally non-significant lesions was found in another ongoing study of FFR-guided revascularization versus initial conservative treatment in ACS patients (STEMI and high-risk NSTEMI) with approximately 20% rate of non-significant lesions by FFR in the angiographic range 90-99% and 50% in the 70-89% range.
In our study we investigated the correlation and prognostic power of resting Pd/Pa and FFR to predict outcomes in 3 years in non-culprit vessels of STEMI patients of the COMPARE-Acute trial who had successful primary PCI.
We found that the resting Pd/Pa had approximately 80% diagnostic accuracy when compared to fractional flow reserve. In case the two indexes were discrepant (approximately 20% of the cases), FFR had better ability to indicate which lesions could be deferred safely.
Our analysis indicates that deferral of an intervention of non-culprit vessels in the acute phase seems to be better aided by FFR compared to resting indexes. Further studies are needed to clarify the optimal approach for these patients.
