Hypertension as a predictor of adverse cardiac events in patients with borderline fractional flow reserve

Abstract

Objective — The cut-off value myocardial fractional flow reserve (FFR_myo) < 0.75 identifies patients with clinically significant coronary stenosis. Normally PCI is deferred with a FFR_myo ≥ 0.75. Other clinical characteristics may affect such treatment decision.Therefore, we studied the association between baseline characteristics and clinical outcomes in an unselected patient cohort with coronary artery disease, with intermediate coronary stenosis, initially referred for PCI, but in whom the intervention was deferred on the basis of FFR_myo ≥ 0.75

Methods — Angiographic analysis and follow-up were performed in 152 patients with stable or unstable angina pectoris with intermediate coronary stenosis severity and normal left ventricular func-tion.A major adverse cardiac event (MACE) was defined as postprocedural acute myocardial infarction (AMI), target vessel revascularization (TVR) and verified cardiac death.

Results — More adverse cardiac events occurred in patients with 0.75 < FFR_myo < 0.80 (24/30) compared with FF ≥ 0.80 (9/97) (P< 0.001). Hypertension, diabetes and hyperlipidaemia were significantly associated with the occurrence of MACE in the univariate analyses. Logistic regression analyses showed that only hypertension remained as a significant independent predictor of MACE for patients with 0.75 ≤ FFR_myo < 0.80 (P< 0.10).

Conclusion — In an unselected patient population with coronary artery disease, a FFR_myo cut-off value of 0.8 should be used in hypertensive patients to discriminate between clinically significant coronary stenosis.

Key Words:

• fractional flow reserve
• percutaneous coronary intervention
• coronary pressure measurement