Favorable impact of FFR on myocardial revascularization outcomes: Results from an observational real-world registry.

Background: Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFR) strategy significantly decreases unnecessary invasive coronary angiography and refines the appropriateness of revascularization decision. The present study aimed to evaluate how FFR guided - strategy impacts outcomes postrevascularization.

Methods: We included patients with suspected obstructive coronary artery disease (OCAD in a registry from 2013 to 2021. FFR entered Heart-Team decision from 2017. Propensity score adjusted Cox - and logistic - regression analyzed FFR's impact on post- revascularization major adverse cardiovascular events (MACE) and myocardial injury (PMI).

Results: Among 7541 patients, 1601 had suspected OCAD. 559 patients underwent revascularization: 69.0 % PCI, 29.7 % CABG and 1.2 % both. 252(45.1 %) patients underwent FFR. Over 4.4 ± 2.2 years, 137(24.5 %) patients experienced MACE. FFR was associated with a trend toward reduced MACE (HR 0.736, 95 % CI 0.513-1.055, p = 0.095) and significantly reduced all-cause mortality (HR 0.476, 95 % CI 0.230-0.985, p = 0.046). In the post-2017 cohort (413 patients, follow-up 3.7 ± 1.5 years), FFR significantly reduced MACE (HR 0.610, 95 % CI 0.390-0.954, P = 0.030) and all-cause mortality (HR 0.285, 95 % CI 0.104-0.779, P = 0.014). In CABG patients, FFR was associated with lower PMI incidence (5.3 % vs. 15.6 %, p = 0.044). Multivariable analysis revealed no significant association between FFR use and PMI.

Conclusions: Revascularization decision-making with FFR translates into better post-revascularization outcomes, primarily by reducing MACE through lower mortality. There was no clear impact on PMI. These findings suggests that FFR's value lies indeed in improving patient selection for revascularization, but warrants further confirmation in randomized clinical trials.