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Prognostic impact of fractional flow reserve measurements in patients with acute coronary syndromes: a subanalysis of the FLORIDA study

Randomized trials suggest benefits for fractional flow reserve (FFR)-guided vs. angiography-guided treatment strategies in well-defined and selected patient cohorts with acute coronary syndromes (ACS). The long-term prognostic value of FFR measurement in unselected all-comer ACS patients, however, r...

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Autores principales: Gerhardt, Teresa, Stähli, Barbara E., Rudolph, Tanja K., Lutz, Matthias, Schatz, Anne-Sophie, Zanders, Lukas, Schubert, Tino, Stueve, Magnus, West, Nick E. J., Boone, Els, Landmesser, Ulf, Leistner, David M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Japan 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290038/
https://www.ncbi.nlm.nih.gov/pubmed/37067577
http://dx.doi.org/10.1007/s00380-023-02256-7
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author Gerhardt, Teresa
Stähli, Barbara E.
Rudolph, Tanja K.
Lutz, Matthias
Schatz, Anne-Sophie
Zanders, Lukas
Schubert, Tino
Stueve, Magnus
West, Nick E. J.
Boone, Els
Landmesser, Ulf
Leistner, David M.
author_facet Gerhardt, Teresa
Stähli, Barbara E.
Rudolph, Tanja K.
Lutz, Matthias
Schatz, Anne-Sophie
Zanders, Lukas
Schubert, Tino
Stueve, Magnus
West, Nick E. J.
Boone, Els
Landmesser, Ulf
Leistner, David M.
author_sort Gerhardt, Teresa
collection PubMed
description Randomized trials suggest benefits for fractional flow reserve (FFR)-guided vs. angiography-guided treatment strategies in well-defined and selected patient cohorts with acute coronary syndromes (ACS). The long-term prognostic value of FFR measurement in unselected all-comer ACS patients, however, remains unknown. This subanalysis of the Fractional FLOw Reserve In cardiovascular DiseAses (FLORIDA) study sought to investigate the long-term effects of FFR in the management of lesions in patients with acute coronary syndrome (ACS). FLORIDA was an observational all-comer cohort study performed in Germany, that was population-based and unselected. Patients enrolled into the anonymized InGef Research Database presenting with ACS and undergoing coronary angiography between January 2014 and December 2015 were included in the analysis. Patients were stratified into either the FFR-guided or the angiography-guided treatment arm, based on the treatment received. A matched cohort study design was used. The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiovascular events (MACE), a composite of death, non-fatal myocardial infarction (MI), and repeat revascularization. Follow-up time was 3 years. Rates of 3-year mortality were 10.2 and 14.0% in the FFR-guided and the angiography-guided treatment arms (p = 0.04), corresponding to a 27% relative risk reduction for FFR in ACS patients. Rates of MACE were similar in both arms (47.7 vs. 51.5%, p = 0.14), including similar rates of non-fatal MI (27.7 vs. 25.4%, p = 0.47) and revascularization (9.9 vs. 12.1%, p = 0.17). In this large, all-comer observational study of ACS patients, FFR-guided revascularization was associated with a lower mortality at 3 years. This finding encourages the routine use of FFR to guide lesion revascularization in patients presenting with ACS. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00380-023-02256-7.
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spelling pubmed-102900382023-06-25 Prognostic impact of fractional flow reserve measurements in patients with acute coronary syndromes: a subanalysis of the FLORIDA study Gerhardt, Teresa Stähli, Barbara E. Rudolph, Tanja K. Lutz, Matthias Schatz, Anne-Sophie Zanders, Lukas Schubert, Tino Stueve, Magnus West, Nick E. J. Boone, Els Landmesser, Ulf Leistner, David M. Heart Vessels Original Article Randomized trials suggest benefits for fractional flow reserve (FFR)-guided vs. angiography-guided treatment strategies in well-defined and selected patient cohorts with acute coronary syndromes (ACS). The long-term prognostic value of FFR measurement in unselected all-comer ACS patients, however, remains unknown. This subanalysis of the Fractional FLOw Reserve In cardiovascular DiseAses (FLORIDA) study sought to investigate the long-term effects of FFR in the management of lesions in patients with acute coronary syndrome (ACS). FLORIDA was an observational all-comer cohort study performed in Germany, that was population-based and unselected. Patients enrolled into the anonymized InGef Research Database presenting with ACS and undergoing coronary angiography between January 2014 and December 2015 were included in the analysis. Patients were stratified into either the FFR-guided or the angiography-guided treatment arm, based on the treatment received. A matched cohort study design was used. The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiovascular events (MACE), a composite of death, non-fatal myocardial infarction (MI), and repeat revascularization. Follow-up time was 3 years. Rates of 3-year mortality were 10.2 and 14.0% in the FFR-guided and the angiography-guided treatment arms (p = 0.04), corresponding to a 27% relative risk reduction for FFR in ACS patients. Rates of MACE were similar in both arms (47.7 vs. 51.5%, p = 0.14), including similar rates of non-fatal MI (27.7 vs. 25.4%, p = 0.47) and revascularization (9.9 vs. 12.1%, p = 0.17). In this large, all-comer observational study of ACS patients, FFR-guided revascularization was associated with a lower mortality at 3 years. This finding encourages the routine use of FFR to guide lesion revascularization in patients presenting with ACS. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00380-023-02256-7. Springer Japan 2023-04-17 2023 /pmc/articles/PMC10290038/ /pubmed/37067577 http://dx.doi.org/10.1007/s00380-023-02256-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Gerhardt, Teresa
Stähli, Barbara E.
Rudolph, Tanja K.
Lutz, Matthias
Schatz, Anne-Sophie
Zanders, Lukas
Schubert, Tino
Stueve, Magnus
West, Nick E. J.
Boone, Els
Landmesser, Ulf
Leistner, David M.
Prognostic impact of fractional flow reserve measurements in patients with acute coronary syndromes: a subanalysis of the FLORIDA study
title Prognostic impact of fractional flow reserve measurements in patients with acute coronary syndromes: a subanalysis of the FLORIDA study
title_full Prognostic impact of fractional flow reserve measurements in patients with acute coronary syndromes: a subanalysis of the FLORIDA study
title_fullStr Prognostic impact of fractional flow reserve measurements in patients with acute coronary syndromes: a subanalysis of the FLORIDA study
title_full_unstemmed Prognostic impact of fractional flow reserve measurements in patients with acute coronary syndromes: a subanalysis of the FLORIDA study
title_short Prognostic impact of fractional flow reserve measurements in patients with acute coronary syndromes: a subanalysis of the FLORIDA study
title_sort prognostic impact of fractional flow reserve measurements in patients with acute coronary syndromes: a subanalysis of the florida study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290038/
https://www.ncbi.nlm.nih.gov/pubmed/37067577
http://dx.doi.org/10.1007/s00380-023-02256-7
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