Completeness of revascularization by FFR in stable angina: Association to adverse cardiovascular outcomes.

Background: The prognostic impact of complete coronary revascularization relative to non-invasive testing methods is unknown.

Objectives: To assess the association between completeness of revascularization defined by CTA-derived fractional flow reserve (FFR) and cardiovascular outcomes in patients with stable angina.

Methods: Multicenter 3-year follow-up study of patients with new onset stable angina and ≥ 30% stenosis by CTA. The lesion-specific FFR value (two cm-distal-to-stenosis) was registered in all vessels with stenosis and considered abnormal when ≤ 0.80. Patients with FFR ≤ 0.80 were categorized as: Completely revascularized (CR-FFR), all vessels with FFR ≤ 0.80 revascularized; incompletely revascularized (IR-FFR), ≥ 1 vessels with FFR ≤ 0.80 non-revascularized. Early revascularization (< 90 days from index CTA) categorized vessels as revascularized. The primary endpoint comprised cardiovascular death and non-fatal myocardial infarction; the secondary endpoint vessel-specific late revascularization and non-fatal myocardial infarction.

Results: Amongst 900 patients and 1759 vessels, FFR was ≤ 0.80 in 377 (42%) patients, 536 (30%) vessels; revascularization was performed in 244 (27%) patients, 340 (19%) vessels. Risk of the primary endpoint was higher for IR-FFR (15/210 [7.1%]) compared to CR-FFR (4/167 [2.4%]), RR: 2.98; 95% CI: 1.01-8.8, p ​= ​0.036, and to normal FFR (3/523 [0.6%]), RR: 12.45; 95% CI: 3.6-42.6, p ​< ​0.001. Incidence of the secondary endpoint was higher in non-revascularized vessels with FFR ≤ 0.80 (29/250 [12%]) compared to revascularized vessels with FFR ≤ 0.80 (5/286 [1.7%]), p ​= ​0.001, and to vessels with FFR > 0.80 (10/1223 [0.8%]), p ​< ​0.001.

Conclusion: Incomplete revascularization of patients with lesion-specific FFR ≤ 0.80 is associated to unfavorable cardiovascular outcomes compared to those with complete revascularization or FFR > 0.80.