Usefulness of the Fractional Flow Reserve Derived by Intracoronary Pressure Wire for Evaluating Angiographically Intermediate Lesions in Acute Coronary Syndrome

Introduction and objectivesIn contrast to findings in stable ischemic heart disease, in acute coronary syndrome (ACS), measurement of the fractional flow reserve (FFR) using an intracoronary pressure wire has not been shown to be useful for evaluating angiographically equivocal coronary lesions. The aim of this study was to analyze outcomes at 1 year in ACS patients with lesions that were classed as intermediate on coronary angiography and which were not nonrevascularized because of the FFR value determined by intracoronary pressure wire.MethodsThe observational study involved a cohort of patients admitted for ACS who had intermediate lesions on coronary angiography that were not revascularized because the FFR was >0.75. Functional studies were not carried out if there was angiographic evidence of instability. All-cause mortality, non-fatal myocardial infarction, revascularization of the target lesion and readmission for cardiac causes in the first year of the study were recorded.ResultsThe study included 106 patients with 127 lesions that were not revascularized because the FFR was >0.75. Their mean age was 69.9±10 years, 92 (86.8%) had non-ST-elevation ACS, the mean angiographic stenosis was 40.5±7.8%, and the mean FFR was 0.88±0.06. There were no complications during the procedure. The follow-up rate at 1 year was 95.1%. Events observed at 1 year were: 2 deaths (total mortality 1.9%), 0 fatal acute myocardial infarctions, 1 (0.9%) target lesion revascularization and 5 (4.7%) readmissions for cardiac causes.ConclusionsOnce lesions with clear angiographic signs of instability are excluded, intracoronary pressure wire measurement could be useful in ACS patients for avoiding unnecessary revascularization of angiographically intermediate coronary lesions.

Introducción y objetivosA diferencia de lo que ocurre con la cardiopatía isquémica estable, en el síndrome coronario agudo (SCA), la reserva fraccional de flujo (RFF) medida con guía intracoronaria de presión no ha demostrado utilidad para evaluar lesiones coronarias angiográficamente dudosas. El objetivo de este estudio es analizar el pronóstico a 1 año de los pacientes con SCA y lesiones intermedias en la coronariografía no revascularizados con base en las cifras de RFF obtenida con guía intracoronaria de presión.MétodosEstudio observacional de una cohorte de pacientes ingresados por SCA con lesiones coronarias de gravedad angiográfica intermedia no revascularizadas por presentar una RFF > 0,75. El estudio funcional no se realizó en presencia de evidencia angiográfica de inestabilidad. Se evaluaron los eventos muerte, infarto no fatal, revascularización de la lesión estudiada y el reingreso por causa cardiaca durante el primer año tras el estudio.ResultadosSe incluyó a 106 pacientes con 127 lesiones no revascularizados por obtenerse una RFF > 0,75. Edad, 69,9 ± 10 años; SCA sin elevación del segmento ST, 92 (86,8%); estenosis angiográfica media, 40,5% ± 7,81%; RFF media, 0,88 ± 0,06. No se observaron complicaciones durante los procedimientos. Se obtuvo un seguimiento al año del 95,1%. Los eventos observados al año fueron: mortalidad total, 2 (1,9%); infarto no fatal, 0; revascularización de la lesión estudiada, 1 (0,9%); reingreso por causa cardiaca, 5 (4,7%).ConclusionesExcluyendo las lesiones con evidentes signos angiográficos de inestabilidad, la guía intracoronaria de presión puede ser una herramienta útil en el SCA para evitar revascularizaciones innecesarias de lesiones coronarias angiográficamente moderadas.