Fractional Flow Reserve to Assess Coronary Artery Disease in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation: Long-Term Outcomes.

Content Provider	Europe PMC
Author	Benseba, Juva Mercier, Julien Couture, Thomas Faroux, Laurent Bernatchez, Laurence Côté, Mélanie Panagides, Vassili Mesnier, Jules Mohammadi, Siamak Dumont, Éric Kalavrouziotis, Dimitri Hadjadj, Sandra Beaudoin, Jonathan DeLarochellière, Robert Rodés-Cabau, Josep Paradis, Jean-Michel
Copyright Year	2023
Abstract	Background The long-term outcomes of patients undergoing functional assessment of coronary lesions with fractional flow reserve (FFR) while awaiting transcatheter aortic valve implantation (TAVI) are unknown. Data on the safety of intracoronary adenosine use in this setting are scarce. The objectives of this study were to describe (1) the long-term outcomes based on the coronary artery disease (CAD) assessment strategy used and (2) the safety of intracoronary adenosine in patients with severe aortic stenosis (AS). Methods 1023 patients with severe AS awaiting TAVI were included. Patients were classified according to their CAD assessment strategy: angiography guided or FFR guided. Patients were further subdivided according to the decision to proceed with percutaneous coronary intervention (PCI): angiography-guided PCI (375/1023), angiography-guided no-PCI (549/1023), FFR-guided PCI (50/1023), and FFR-guided no-PCI (49/1023). Patients were followed up for the occurrence of major adverse cardiac and cerebrovascular events (MACCEs). Results At a mean follow-up of 33.7 months, we observed no significant differences in terms of major adverse cardiovascular and cerebrovascular events (MACCE) in the angiography-guided group (42.4%) compared with the FFR-guided group (37.4%) (p = 0.333). When comparing outcomes of the FFR-guided no-PCI group (32.7%) with the angiography-guided PCI group (46.4%), no significant difference was noted (p = 0.999). Following intracoronary adenosine, a single adverse event occurred. Conclusions In this population, intracoronary adenosine is safe and well tolerated. We found no significant benefit to an FFR-guided strategy compared with an angiography-guided strategy with respect to MACCEs. Although clinically compelling, avoiding the procedural risks of PCI by deferring the intervention in functionally insignificant lesions failed to show a statistically significant benefit.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC10382974&blobtype=pdf
ISSN	24748706
Volume Number	7
DOI	10.1016/j.shj.2023.100179
PubMed Central reference number	PMC10382974
Issue Number	4
PubMed reference number	37520135
Journal	Structural Heart [Struct Heart]
e-ISSN	24748714
Language	English
Publisher	Elsevier
Publisher Date	2023-04-18
Access Restriction	Open
Rights License	This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). © 2023 The Author(s)
Subject Keyword	Aortic valve stenosis Coronary artery disease Fractional flow reserve Intracoronary adenosine Transcatheter aortic valve implantation
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine