Performance and 12-month Outcomes of a Wire-free Fractional Flow Reserve System for Assessment of Coronary Artery Disease

Chandan Deepak, Bhavnani and Alan Yean Yip, Fong and Keng Tat, Koh and Ing, Xiang Pang and Lean Seng, Chen and Hwei Sung, Ling and Lee Karl, Thien and Bui Khiong, Chung and Chen Ting, Tan and Yen Yee, Oon and Kian Hui, Ho and Francis Eng Pbeng, Shu and Asri, Said and Yee Ling, Cham and Tiong Kiam, Ong (2022) Performance and 12-month Outcomes of a Wire-free Fractional Flow Reserve System for Assessment of Coronary Artery Disease. Journal of Asian Pacific Society of Cardiology. pp. 1-5. ISSN 2754-0650

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Abstract

Background: Fractional flow reserve (FFR) using an invasive pressure wire is recommended to guide coronary revascularisation in stable coronary artery disease. Coronary angiography-based wire-free FFR (CAFFR) determines the significance of a coronary lesion without the requirement of a pressure wire. Deferral of revascularisation of coronary lesions with an FFR >0.8 has been shown to have similar outcomes to patients managed with optimal medical therapy. Objective: The aim of our study was to assess the performance and 12-month clinical outcomes in patients with CAFFR-guided percutaneous coronary intervention (PCI) deferral. Methods: This was a prospective study involving 69 patients (93 vessels) with angiographic stenosis of 30–90%. Patients with CAFFR ≤0.80 or poor image quality were excluded, leaving 29 patients (31 vessels) for analysis. All recruited patients had a CAFFR >0.80 and thus, PCI deferral. This cohort was followed up for 12 months. The primary endpoint was a composite of death from any cause, MI or target vessel revascularisation. Wired FFR was done for comparison on 14 patients (48%) at the operator’s discretion. Results: The mean age was 59.9 (±12.6) years. The majority of patients were men (83%; n=24), 41% (n=12) had diabetes, 62% (n=18) had hypertension, 59% (n=17) had dyslipidaemia, 62% (n=18) had a history of smoking. The mean left ventricular ejection fraction (LVEF) was 52 (±11.4)% and 76% of the patients had a recent acute coronary syndrome. We assessed the left anterior descending artery and 52% (n=16) of vessels had a mean CAFFR was 0.87. At 12 months, all patients were alive, 89.7% remained in chronic coronary syndrome (CCS) class 1 and 3.4% (n=1) of the study population met the primary outcome of target vessel revascularisation. Conclusion: CAFFR showed good agreement with wire-based FFR and 12-month outcomes showed that CAFFR-guided deferral of PCI was safe and comparable to wired-based FFR guidance.

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