Outcomes of Lesions With Discordance Between FFR and Nonhyperemic Pressure Ratios.

Overview

abstract

BACKGROUND: Discordance between fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs) can occur in about 20% of clinical cases, creating treatment dilemmas in the cardiac catheterization laboratory. OBJECTIVES: The authors sought to perform a systematic review and meta-analyses investigating the long-term outcome of deferral strategy in patients found to have discordant physiology. METHODS: The primary comparison tested the long-term prognosis of patients who were deferred for discordant physiology vs those deferred for concordant negative results. Various NHPRs were compared with FFR. The primary endpoint was a composite of death (all-cause or cardiac) and myocardial infarction/revascularization with several definitions. Secondary endpoint consisted of death or myocardial infarction. The study is registered with PROSPERO (CRD42024628393). RESULTS: Six eligible trials with 9,854 intermediate lesions deferred for PCI were considered in the analysis. Compared with concordant-negative physiology (FFR^-/NHPRs^-), deferral of PCI for discordant physiology was associated with an increase in the primary endpoints (FFR^-/NHPRs⁺: HR: 2.73 [1.95-3.80]; P < 0.00001 and FFR⁺/NHPRs^-: HR: 3.29[2.33-4.64]; P < 0.00001). Secondary dichotomous analysis showed that deferral of PCI in both discordant groups was associated with an increase in the hard endpoints (death or myocardial infarction) compared with concordant-negative physiology. Exploratory analysis comparing revascularization vs deferral groups within discordant physiology demonstrated reduction in the primary endpoint in the FFR⁺/NHPRs^- group, but not in the FFR^-/NHPRs⁺ group. CONCLUSIONS: Deferral of PCI in discordant-physiology was associated with worse long-term outcomes compared with the concordant-negative physiology. There may be a benefit of revascularization in FFR⁺/NHPRs^- lesions, which requires further investigation.